Templates for General Practice 

The following templates are for General Practice to download into their CIS.

Please access the relevant instruction sheets for information on how to import these templates to your program of choice:

TemplateDate as ofBest PracticeMedical Director
LHD Request for Endscopy November 2019
Far West Referral to Outpatient Clinic November 2019
LHD Dubbo Direct Access Colonscopy November 2019
LHD Bathurst High Risk Foot Referral November 2019
Bathurst After Hours Medical Service - Patient Form for RACF Visits February 2018
Orange - Colonoscopy Referral for Positive Faecal Occult Blood Test February 2018
Death Certificate (NSW)

June 2019

Diabetes Shared Care Plan Template (Dubbo Diabetes Project)  June 2017
Dubbo After Hours Medical Service - Patient Form for RACF Visits  February 2018
Dubbo High Risk Foot Service Referral Form - Western NSW LHD October 2018
Dubbo Neurophysiology Ambulatory Care - Western NSW LHD July 2018
Geriatric Medicine Clinic Referral Form March 2019
Integrated Chronic and Complex Care – Referral Form  March 2019
Lung Cancer Fast Track Clinical Referral - Western NSW LHD May 2019
Marrabinya Referral Form

May 2019


Strong Minds Western - GP Referral and Mental Health Treatment Plan October 2017
Lourdes Hospital Hydrotherapy Referral July 2018
Lourdes Hospital Pre-Admission Referral July 2018
Orana Mall Sleep Study Referral Form October 2019
Pink Angels       Patient Referral Form                GP Referral instructions