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Primary Health Tasmania

PHN-Central and Eastern Sydney - Large collection, but quite a few do not pre-populate.

PHN-Darling Downs

PHN-Murrumbidgee

PHN-South Western Sydney

PHN-Central Queensland

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Chronic Disease Related

Asthma Care Plan for Education or Care Services MD BP

Asthma Foundation of Tasmania Patient Education Referral MD BP

GP Eating Disorders Plan (EDP) MD BP

Sick Leave Action Plan - Type 2 Diabetes MD BP

NDSS BG Test Strip 6 month Approval MD BP

Hep C Virus GPMP and Team Care MD BP

Referral Forms

Alcohol and Drug Service (ADS) Intake and Referral MD BP

All About Wounds Referral MD BP ^{Nov 2021}

Better Start initiative Referral MD BP

Calvary Cardiac Centre MD BP

Cannabis Access Clinics Referral MD BP

Carers Australia Tasmania Referral MD BP

Child and Adolescent MH Referral (CAMHS) - South MD BP

Child and Adolescent MH Referral (CAMHS) - North/NW MD BP ^{July 2020}

Child Health and Parenting Service - Walker House MD BP

Community Continence Service THS-North Referral MD BP

Community Health Social Work THS-North Referral MD BP

Community Dementia Service THS-North Referral MD BP

DBMAS Referral - Dementia Support Australia MD BP

Derwent Eye Specialists MD BP

Early Childhood Intervention Service (ECIS) Referral MD BP

ForensiClinic Referral MD BP

Health Dynamics Statewide Referral MD BP ^{March 2021}

Hobart Cardiology Cardiac Testing Request MD BP

Hobart Cardiology Lung Function Request MD BP

Huon Valley Multi-Service Referral Form MD BP PDF

Huon Valley Health Centre - Social Worker Referral MD

Integrated Physiotherapy Referral MD BP

LGH Cardiology Referral MD BP

LGH Cardiac Catheterisation Referral MD BP ^{Jan 2021}

Dr Mark Wilson Referral MD BP

Mental Health Nurse Program Referral MD BP Consent form MD BP ^Sep/2020

MyAgedCare Referral MD BP

Nephrologist Referral Form (Generic) MD BP

Neurosensory Referral MD BP ^Sep/2020

OT Services Community Team South Referral MD BP

Dr William Osler Referral MD BP

Partners in Recovery (PIR) MD BP

PlantMed Cannabis Clinic Referral MD BP ^{Jul 2021}

Princes Square Cardiology MD BP

Quitline Referral MD BP ^{Oct 2021}

RHH Paedeatric Allergy Clinic - Skin Prick Testing Referral MD BP

RHH Ambulatory Care Centre Request/Referral MD BP ^May/2021

Royal Flying Doctor Service - Youth MH Referral MD BP

SETAC Referral Form MD BP

Sexual Assault Support Service (SASS) MD BP ^{Nov 2020}

Sleep Better Again, - Referral MD BP - Holter Monitoring MD BP

SleepClinic Services Australia MD BP

Sleep Services Australia MD BP

St Giles DAT Team Referral (North) MD BP ^{Jul
2021}

Tas Autism Diagnostic Services (TADS) Referral (Paediatric) MD BP

Tasmanian Cardiac Care Echocardiogram Referral MD BP

Tasmanian Community Clinic Referral MD BP

THS North Allied Health Referral MD BP

THS Specialist Palliative Care Referral MD BP ^{Oct 2020}

THS Wetaway Intake Form MD BP ^{Feb 2022}

University Psychology Clinic - Child Services Referral MD BP

Wellways to Health Program Referral MD BP

Women's Health Fund referral and Provider Form MD BP ^{Sept 2021}

Requests

Berera/QScan Imaging Request MD BP ^{Jun 2020}

Cardiac Rhythm Diagnostics Holter monitor MD BP ^{April 2022}

Hobart Pathology PreNatal Testing MD BP ^{Sept 2020 ^{(MD users
set 5mm margins all round)}}

LGH Fibroscan Request MD BP ^{May 2021}

LGH EEG Request MD BP ^{Mar 2022}

LGH - Supply of Home Oxygen Request MD BP

Lung Function Request THS-South MD BP ^{Nov 2020}

MRI Request THS-South MD BP ^{Nov
2021 (MD users
set 5mm margins all round)}

RHH Imaging Request MD BP ^{March 2021}

Samsas Maternal Serum Screening MD BP ^{Jun 2020}

VCGS Percept pre-natal test MD BP ^{Jun 2021}

VCGS Prepair pre-natal test MD BP ^{Jun 2021}

Miscellaneous

Advance Care Directive MD BP ^{Dec 2020} Further Information

Adverse Event following Immunisation (National) (NAEFI) form MD BP ^{March
2021}

Allergic Rhinitis Treatment Plan MD BP

Application to prescribe Amfetamine or related for Adults MD BP ^{Oct 2021}

Application to prescribe Amfetamine or related for Adolescents MD BP ^{Feb 2022}

Blood Pressure 7 Day Diary (Landscape Format) MD BP ^{Aug 2020}

Continence Aids Payment Scheme (CAPS) MD BP ^{Oct 2021}

Corporate Services Net Doctors Progress Report MD BP ^{Sep 2020}

COVID-19 Letter to school or employer (RACGP) MD BP ^{Aug 2020}

COVID-19 Vaccination consent form MD BP ^09/04/21

COVID-19 Vaccination Exemption/Medical Contraindication MD BP ^11/02/22

COVID-19 Vaccination - Eligible to receive a 3rd dose of Pfizer MD BP ^04/11/21

DASS 21 MD BP

DVA D09382 Medical Cerificate Ability to Work MD BP ^{Feb 2021}

DVA D9287 Diagnosis MD BP ^{May 2021}

FOBT Negative Letter MD BP

General Practitioner Assessment of Cognition (GPCOG) MD BP

MAIB Form J MD BP

NPS Opioid Tapering Plan MD BP ^{May 2021}

Pain Assessment and Documentation Tool (PADT) MD BP

PIP Indigenous Health incentive patient registration and consent MD BP ^{July 2021}

PBS Authority Narcotic Restrictions MD BP

Zostavax Screening for Contraindications MD BP

Import Instructions

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