Welcome to Midwest GP Network |

07 February 2012 | |

Midwest GP Network | 32 Holland Street GERALDTON WA 6530 | PO Box 2638 GERALDTON WA 6531
Tel (08) 9920 7100 | Fax (08) 9964 3487 | mail@gpnetwork.org.au

Topics

The available templates are under the following sections:

  • Administration
  • Carers
  • Children Health
  • Chronic Diseases Managment and MBS items
  • Geriatric
  • Mental Health
  • Prescriptions - Medicines, Oxygen
  • Specialists Referral Forms

If you forgot how to create a new template in your medical software, read this document that explains how it is done in MD3 (Same principle applies in Best Practice).

Administration
DCP Mandatory Reporting Form
You will find this form in a PDF format (to hand write), in a doc format, or as templates for MD3 or BP  (rtf format).

Do not open the template before importing into your medical software
 		   

Created: 05 May 2011
DVA - Travel Request Form

This Department and Veteran Affairs form is available in fax format (.doc), or in templates for MD3 and Best Practice.

Do not open the templates prior to importing in medical softwares.

 		   

Created: 19 January 2011
MGPN Membership Application Form
To become a member of the Midwest GP Network, Complete this form and fax it to the Midwest GP Network.    

Created: 10 May 2010
Locum Request

Application to request regional locum, to complete and return to Midwest GP Network.

 		   

Created: 10 May 2010
Carers
Midwest Carer Respite Referral

 This form is available either in PDF form or as a MD/BP template.

Do not open the template before importing into your medical software.

 		   

Created: 10 May 2010
Needs Assessment

This is a MD/BP template. Do not open it before importing into your medical software.

 		   

Created: 10 May 2010
Children Health
Children Development Services
Find below the referral form to the Children Development Services: Form MR69B for children and MR69C for children of school age. (extension doc and pdf  to complete manually.)

Also available in Medical Director and Best Practice templates: (extension rtf - do not open prior to import in medical software).
 		   

Created: 29 August 2011
Chronic Diseases Managment and MBS items
Lifescript templates for MD3
Lifescript for Alcohol, Smoking, Nutrition and Physical Activities template for MD3 are in this section (Source DoHA).

Do not open prior to import in MD3 		   

Created: 05 May 2011
Lifescript templates for Best Practice
Lifescript templates available for Alcohol, Smoking, Nutrition and Physical Activities for Best Practice. (Source DoHA).

Do not open templates before importing into your Best Practice. 		   

Created: 05 May 2011
Modified Lifescript templates for Best Practice
These templates for Lifescript Alcohol, Smoking, Nutrition and Physical Activity are modified to be entirely completed within Best Practice.

Do not open before importing in Best Practice. 		   

Created: 05 May 2011
WACHS Dietetic Referral form

This form is available in fax format.

 		   

Created: 29 September 2010
Lifestyle Modification Program

GP referral to a Lifestyle Modification Program under the prevention of type 2 diabetes program, from AGPN. This form is available in a document format (editable with Word - 6MB slow to download) or in MD3 Template (25KB)

Do not open the MD3 template before importing.

 		   

Created: 11 May 2010
Referral form for Allied Health Group Services

 Referral form for Allied Health Group Services under Medicare for patients with type 2 diabetes.

MD3 template - Do not open before importing.

 		   

Created: 11 May 2010
GP Management Plan

MBS Item 725

Template to import into MD/BP. (Do not open it before importing.)

 		   

Created: 10 May 2010
Combined GP Management Plan & Team Care Arrangement

MBS items 721 and 723.
MBS Item 732 (Nov 2010).

When downloading the template (.rtf), do not open the file before importing into your Medical software (MD/BP).

 		   

Created: 10 May 2010
Team Care Arrangement

TCA only - MBS Item 723

This is a MD/BP template. Do not open it before importing.

 		   

Created: 10 May 2010
Geriatric
WACHS Occupational Therapy Outpatient

This form is available in PDF format to fax or as a template for MD/BP.

Do not open the template before importing in your medical software.

 		   

Created: 03 June 2010
ACAT Referral

Aged Care Assessment : This form is available in fax format (.doc) or in Md/BP template (.rtf).

Do not open the template before importing into MD/BP.

 		   

Created: 10 May 2010
WACHS Geriatrician consultation request

 This form is available either as a fax format (doc) and as a MD/BP template.

Do not open the template before importing into MD/BP

 		   

Created: 10 May 2010
Mental Health
MGPN Mental Health Referral form

The Mental Health Referral form is available in fax format (.doc)

(MD/BP template (.rtf) will come soon....)

 

 		   

Created: 10 May 2010
K10 form

Mental Health assessment form.

 		   

Created: 10 May 2010
Edinburgh post natal depression scale

Mental Health assessment form

 		   

Created: 10 May 2010
Prescriptions - Medicines, Oxygen
Application to prescribe a drug of addiction
This DoHA application is available in a fax format (doc), or a template for MD or Best Practice.

Do not open the template before importing into your medical software. 		   

Created: 24 May 2011
Domiciliary Oxygen Therapy Prescription

The guidelines and prescribing/review process are explained in the PDF files.  This form is available in PDF format, in Word doc format and in MD3/BP template (.rtf).

Do not open the template before importing

 		   

Created: 13 September 2010
Opioid Medicine Treatment Contract

Treatment contract for the use of opioid medicine (morphine-like painkiller) for the management of chronic pain.

MD/BP template - do not open before importing.

 		   

Created: 11 May 2010
HMR Referral

Referral to send to Pharmacists. Templates to import in your medical software (rtf is for MD/BP, mtd is for MedTech).

 		   

Created: 10 May 2010
Medication Management Plan

This plan exist as a PDF form or as a template to import in your medical software (rtf for MD/BP, mtd for MedTech 32).

Please do not open it before importing into MD/BP.

 		   

Created: 07 April 2010
Specialists Referral Forms
St John Of God ProActive Referral

St John of God Pro–Active Occupational Rehabilitation and Injury Prevention Service referral is available in fax format (.doc) or in template formats for MD and BP. 

MD/BP template - do not open before importing.

 		   

Created: 28 February 2011
Closing the Gap - MGPN Referral

Referral Form for  MGPN Indigenous Care Coordinator Supplementary Service (ICCSS) and Indigenous Outreach Worker Service (IOW)  is available in fax format (.doc) or in template for MD and BP (.rtf)
 

Do not open the templates prior to import in the medical software.

 		   

Created: 28 February 2011
Osteoporosis Solutions Referral form

Please find this form in fax format (.doc) and in a template for MD (.rtf).

Do not open the template before importing.

 		   

Created: 28 February 2011
KEMH Request for Outpatient Appointment

This referral form is available in a PDF or Word format, and in templates for MD3 and Best Practice (rtf).

Do not open the templates prior to import in the medical software.  After importing the MD3 template, you may need to change the page setup - margins to print correctly.  

 		   

Created: 19 January 2011
Hearing West Audiology Referral

This form is available in Word format (.doc) and in template formats for MD3 and BP medical software.

Do not open the templates prior to import in medical softwares.

 		   

Created: 19 January 2011
Geraldton & Midwest MRI request form

This form is available in Word format (doc), and as templates for MD3 or BP (.rtf)

Please do not open the templates before importing in your medical software.

 		   

Created: 17 January 2011
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