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 25/03/2020 ITC referral [ Word ] (Bidgerdii) Last updated 05/12/2019 ITC referral Yoonthalla Services [RTF] (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 |
| Sunshine Coast Eating Disorder Trial | Doctor referral form [RTF] | ||
| 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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| Stepped care mental health services | PHN Mental Health Intake [RTF] | ||
| Therapeutic Referral | QuIHN Therapeutic Referral [DOCX] | ||
| 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 CCSS Referral (Bidgerdii) |
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 |
SOPD referral form CQ wide [RTF] |
Information Sheet [PDF] SCHHS eReferral [RTF] Gympie eReferral [RTF] Fax Cover Sheet [RTF] Fax Sheet info |
WBHHS eReferral [RTF] – Last updated 16/04/2019 |
| Gastroenterology procedural referral | CQHHS Endoscopy referral form [RTF] |
SCHHS Open Access Endoscopy eReferral v5 [RTF] View on HealthPathways |
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] Entry patient questionnaire [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 [RTF] Pulmonary Rehabilitation Referral Form [PDF] |
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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| Sunshine Coast Eating Disorder Trial | Doctor referral form [RTF] | ||
| 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 PEN CS Recipes |
Referral form [RTF] GP Referral Form [PDF] – Last updated 17/10/2018 PEN CS Recipes |
Referral form [RTF] GP Referral Form [PDF] – Last updated 17/10/2018 View on HealthPathways PEN CS Recipes |
| SCHHS Clinical Investigation Unit |
Nerve Conduction Studies (NCS) referral form [RTF] Electroencephalogram (EEG) referral form [RTF] |
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| Public Allied Health Services |
CQHHS Sub Acute Care and Chronic Rehabilitation referral form [RTF] |
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| Nurse Navigator Service |
SCHHS Nurse Navigator Service Referral [PDF] Nurse Navigator Service information [PDF] Nurse Navigator Referral Criteria |
WBHHS Nurse Navigator Service Referral [PDF] – Last updated 17/10/2018 View on HealthPathways |
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| Stepped care mental health services | PHN Mental Health Intake [RTF] | PHN Mental Health Intake [RTF] | PHN Mental Health Intake [RTF] |
| Therapeutic Referral | QuIHN Therapeutic Referral [DOCX] | ||
| 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 |
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| 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 |
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| Gastroenterology procedural referral |
Colonoscopy/Endoscopy Referral Form [PDF] – Last updated 07/01/2019 View on HealthPathways |
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| 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 |
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| 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 |
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| 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 |
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| Gastroenterology procedural referral | SCHHS Open Access Endoscopy Referral [PDF] |
Colonoscopy/Endoscopy Referral Form [PDF] – Last updated 01/07/2019 View on HealthPathways |
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| 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
*Please note that since some of the new templates have been delayed, we will accept referrals through your usual template/method until further notice.
Referrals can also be made using this general template until further notice:
All areas: PHN Mental Health Intake [PDF)
Medical Director templates (.rtf file – right click and save this form)
Central Queensland: PHN Mental Health Intake [RTF]
Sunshine Coast: PHN Mental Health Intake [RTF]
Wide Bay: PHN Mental Health Intake [RTF]
Best Practice templates
Central Queensland: COMING SOON
Sunshine Coast: PHN Mental Health Intake [RTF]
Wide Bay: COMING SOON
Genie
COMING SOON
ZedMed
COMING SOON
Referrals from allied health professionals/community organisations
All areas: PHN Mental Health Intake [PDF)
Self-referral or referral from family or friends
All areas: PHN Mental Health Intake [PDF)
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 Eating Disorders Plan [RTF]
- 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 and 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.