Templates and forms
Find referral templates for practice software below.
Ensure you follow instructions on how to open the templates.
Referral templates
Central Queensland |
Sunshine Coast |
Wide Bay |
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| Aboriginal and Torres Strait Islander Chronic Disease Management (CCSS and ITC) |
ITC Referral for Nhulundu (Gladstone and Banana) [PDF] – Last updated 15/01/2019 ITC referral [ Word ] (Bidgerdii) Last updated 05/12/2019 ITC referral (Woorabinda) |
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ITC Referral for Bundaberg [PDF] Last updated 09/07/2019 ITC Referral for Bundaberg [RTF] Last updated 09/07/2019 ITC Referral for Fraser Coast [RTF] ITC Referral for North Burnett [RTF] – Last updated 31/07/2018 |
| Hospital and Health Service Specialist Outpatient Departments eReferral template | Coming soon. |
Information Sheet [PDF] SCHHS eReferral [RTF] Gympie eReferral [RTF] Fax Cover Sheet [RTF] |
WBHHS eReferral [RTF] – Last updated 16/04/2019 |
| Gastroenterology procedural referral | No additional templates required |
Colonoscopy/Endoscopy Referral Form [RTF] – Last updated 17/10/2018 Colonoscopy/Endoscopy Referral Form [PDF] – Last updated 07/01/2019 View on HealthPathways |
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| Persistent Pain | No additional templates required |
Referral form [PDF] |
Referral form [PDF] Entry patient questionnaire [PDF] Rural Chronic Pain Self-Management Group [PDF] – Last updated 18/07/2018 View on HealthPathways |
| Children’s Health Queensland | Access templates | Access templates | Access templates |
| Pulmonary Rehabilitation |
View on HealthPathways Pulmonary Rehabilitation Referral Form – Hervey Bay Physio [RTF] – Last updated 12/10/2018 Pulmonary Rehabilitation Referral Form – Hervey Bay Physio [DOCX] – Last updated 12/10/2018 Pulmonary Rehabilitation Referral Form – Hervey Bay Physio [PDF] – Last updated 12/10/2018 |
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| Hepatitis C Treatment MDT | SCHHS Hep C Referral [RTF] | SCHHS Hep C Referral | |
| My Health For Life |
Referral form [RTF] GP Referral Form [PDF] – Last updated 17/10/2018 |
Referral form [RTF] GP Referral Form [PDF] – Last updated 17/10/2018 |
Referral form [RTF] GP Referral Form [PDF] – Last updated 17/10/2018 View on HealthPathways |
| SCHHS Clinical Investigation Unit | |||
| Nurse Navigator Service |
Nurse Navigator Service referral form [PDF] |
WBHHS Nurse Navigator Service Referral [PDF] – Last updated 17/10/2018 View on HealthPathways |
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| Artius Referrals | Artius Referral Template [RTF] | Artius Referral Template [RTF] | Artius Referral Template [RTF] |
| Therapeutic Referral | QuIHN Therapeutic Referral [DOCX] | ||
| Partners in Recovery | Partners in Recovery CQ [RTF] | View on HealthPathways | |
| Ophthalmology |
Ophthalmology referral form [PDF] – Last updated 17/10/2018 View on HealthPathways |
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| Vaccination History or Catchup | WBHSS Referral Template [RTF] – Last updated 17/10/2018 | ||
| Rural Allied Health – Community Health | Rural Allied Health Referral Template [PDF] – Last updated 17/10/2018 | ||
| Rural Primary Health Services | RPHS Referral Template [RTF] – Last updated 8/11/2018 |
Central Queensland |
Sunshine Coast |
Wide Bay |
|
| Aboriginal and Torres Strait Islander Chronic Disease Management (CCSS) |
ITC Referral for Nhulundu (Gladstone and Banana) [PDF] – Last updated 15/01/2019 |
ITC Referral for Bundaberg [PDF] ITC Referral for Bundaberg [RTF] ITC Referral for Fraser Coast [RTF] ITC Referral for North Burnett [RTF] – Last updated 31/07/2018 |
|
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Hospital and Health Service Specialist Outpatient Departments eReferral template |
Coming soon. |
Information Sheet [PDF] SCHHS eReferral [RTF] Gympie eReferral [RTF] Fax Cover Sheet [RTF] |
WBHHS eReferral [RTF] – Last updated 16/04/2019 |
| Gastroenterology procedural referral | No additional templates required |
Colonoscopy/Endoscopy Referral Form [RTF] – Last updated 17/10/2018 Colonoscopy/Endoscopy Referral Form [PDF] – Last updated 07/01/2019 View on HealthPathways |
|
| Persistent Pain | No additional templates required |
Referral form [PDF] |
Referral form [PDF] Entry patient questionnaire [PDF] Rural Chronic Pain Self-Management Group [PDF] – Last updated 18/07/2018 View on HealthPathways |
| Pulmonary Rehabilitation |
View on HealthPathways Pulmonary Rehabilitation Referral Form – Hervey Bay Physio [RTF] – Last updated 12/10/2018 Pulmonary Rehabilitation Referral Form – Hervey Bay Physio [DOCX] – Last updated 12/10/2018 Pulmonary Rehabilitation Referral Form – Hervey Bay Physio [PDF] – Last updated 12/10/2018 |
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| Children’s Health Qld | Access templates | Access templates | Access templates |
| Hepatitis C Treatment MDT | SCHHS Hep C Referral [RTF] | SCHHS Hep C Referral [RTF] | |
| My Health For Life |
Referral form [RTF] GP Referral Form [PDF] – Last updated 17/10/2018 |
Referral form [RTF] GP Referral Form [PDF] – Last updated 17/10/2018 |
Referral form [RTF] GP Referral Form [PDF] – Last updated 17/10/2018 View on HealthPathways |
| SCHHS Clinical Investigation Unit | |||
| Nurse Navigator Service |
SCHHS Nurse Navigator Service Referral [PDF] |
WBHHS Nurse Navigator Service Referral [PDF] – Last updated 17/10/2018 View on HealthPathways |
|
| Artius Referrals | Artius Referral Template [RTF] | Artius Referral Template [RTF] | Artius Referral Template [RTF] |
| Therapeutic Referral | QuIHN Therapeutic Referral [DOCX] | ||
| Partners in Recovery | Partners in Recovery CQ [RTF] | View on HealthPathways | |
| Ophthalmology |
Ophthalmology referral form [PDF] – Last updated 17/10/2018 View on HealthPathways |
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| Vaccination History or Catchup | WBHSS Referral Template [RTF] – Last updated 17/10/2018 | ||
| Rural Allied Health – Community Health | Rural Allied Health Referral Template [PDF] – Last updated 17/10/2018 | ||
| Rural Primary Health Services | RPHS Referral Template [RTF] – Last updated 8/11/2018 |
Central Queensland |
Sunshine Coast |
Wide Bay |
|
| Hospital and Health Service Specialist Outpatient Departments eReferral template | SCHHS eReferral [RTF] | ||
| Persistent Pain | No additional templates required |
Referral form [PDF] |
Referral form [PDF] Entry patient questionnaire [PDF] Rural Chronic Pain Self-Management Group [PDF] – Last updated 18/07/2018 View on HealthPathways |
| Pulmonary Rehabilitation | Pulmonary Rehabilitation Referral Form [PDF] |
View on HealthPathways Pulmonary Rehabilitation Referral Form – Hervey Bay Physio [DOCX] – Last updated 12/10/2018 Pulmonary Rehabilitation Referral Form – Hervey Bay Physio [PDF] – Last updated 12/10/2018 |
|
| Children’s Health Queensland here | Access templates | Access templates | Access templates |
| Hepatitis C Treatment MDT | SCHHS Hepatitis eReferral [RTF] | SCHHS Hepatitis eReferral [RTF] | |
| My Health For Life |
Updated Referral form [RTF] GP Referral Form [PDF] – Last updated 17/10/2018 |
Updated Referral form [RTF] GP Referral Form [PDF] – Last updated 17/10/2018 |
Updated Referral form [RTF] GP Referral Form [PDF] – Last updated 17/10/2018 View on HealthPathways |
| SCHHS Clinical Investigation Unit | |||
| Nurse Navigator Service |
SCHHS Nurse Navigator Service Referral [PDF] |
WBHHS Nurse Navigator Service Referral [PDF] – Last updated 17/10/2018 View on HealthPathways |
|
| Gastroenterology procedural referral |
Colonoscopy/Endoscopy Referral Form [PDF] – Last updated 07/01/2019 View on HealthPathways |
||
| Therapeutic Referral | QuIHN Therapeutic Referral [DOCX] | ||
| Partners in Recovery | View on HealthPathways | ||
| Ophthalmology |
Ophthalmology referral form [PDF] – Last updated 17/10/2018 View on HealthPathways |
||
| Rural Allied Health – Community Health | Rural Allied Health Referral Template [PDF] – Last updated 17/10/2018 |
Central Queensland |
SunshineCoast |
Wide Bay |
|
| Persistent Pain | No additional templates required |
Referral form [PDF] |
Referral form [PDF] Entry patient questionnaire [PDF] Rural Chronic Pain Self-Management Group [PDF] – Last updated 18/07/2018 View on HealthPathways |
| Pulmonary Rehabilitation | Pulmonary Rehabilitation Referral Form [PDF] |
View on HealthPathways Pulmonary Rehabilitation Referral Form – Hervey Bay Physio [DOCX] – Last updated 12/10/2018 Pulmonary Rehabilitation Referral Form – Hervey Bay Physio [PDF] – Last updated 12/10/2018 |
|
| Children’s Health Queensland here | Access templates | Access templates | Access templates |
| Nurse Navigator Service |
SCHHS Nurse Navigator Service Referral [PDF] |
WBHHS Nurse Navigator Service Referral [PDF] – Last updated 17/10/2018 View on HealthPathways |
|
| Gastroenterology procedural referral | SCHHS Open Access Endoscopy Referral [PDF] |
Colonoscopy/Endoscopy Referral Form [PDF] – Last updated 01/07/2019 View on HealthPathways |
|
| Therapeutic Referral | QuIHN Therapeutic Referral [DOCX] | ||
| My Health for Life | GP Referral Form [PDF] – Last updated 17/10/2018 | GP Referral Form [PDF] – Last updated 17/10/2018 |
GP Referral Form [PDF] – Last updated 17/10/2018 View on HealthPathways |
| Partners in Recovery | View on HealthPathways | ||
| Ophthalmology |
Ophthalmology referral form [PDF] – Last updated 17/10/2018 View on HealthPathways |
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| Rural Allied Health – Community Health | Rural Allied Health Referral Template [PDF] – Last updated 17/10/2018 |
- Secure Web Transfer and eHealth:
- STS AddressBook Individual Update Form: This document is used for General Practitioners to update their information within the Queensland Health – STS (Secure Transfer Services) AddressBook for registration to the Health Provider Portal (HPP).
- STS AddressBook Update Form: This document is used for General Practices to update their information within the Queensland Health – STS (Secure Transfer Services) AddressBook for the delivery of Discharge Summaries and Clinical Letters.
- STS AddressBook Individual Update Form: This document is used for General Practitioners to update their information within the Queensland Health – STS (Secure Transfer Services) AddressBook for registration to the Health Provider Portal (HPP).
- Brisbane hospital referrals
- Paediatric Statewide Referral Criteria
- The Queensland Pelvic Mesh Service offers comprehensive assessment and treatment for women with complications from pelvic mesh. Access to resources and referral forms is via the QPMS website
GP plans and forms
- GP Management Plan [PDF]
- GP Management Plan [RTF – Right click, save as. Medical Director and Best Practice]
- Team Care Arrangements [PDF]
- Team Care Arrangements [RTF – Right click, save as. Medical Director and Best Practice]
- Combined GP Management Plan and Team Care Arrangements [PDF]
- Combined GP Management Plan and Team Care Arrangements [RTF – Right click, save as. Medical Director and Best Practice]
- GP Mental Health Care Plan Template [doc]
- GP Mental Health Treatment Plan Template – Minimal Requirements [doc] – Last updated 31/07/2018
- GP Heart Health Assessment BP (RTF – Right click, save as)
- GP Heart Health Assessment MD (RTF – Right click, save as)
How to use templates
Right click. Save template
Open template in your software
- View opening instructions for Best Practice templates
- View opening instructions for Medical Director templates
- View opening instructions for ZedMed templates
- Contact your Practice Support Officer if you require additional support.