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:
Respiratory Clinics
Template |
Date Effective |
Word Doc |
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Best Practice |
Medical Director |
Respiratory Clinics | May 2020 | ![]() |
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WNSW PHN Region-wide Templates
Template |
Date Effective |
Best Practice |
Medical Director |
Strong Minds Western - GP Referral and Mental Health Treatment Plan | February 2020 | ![]() |
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Early Childhood Intervention Intake and Consent Form | April 2020 | ![]() |
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COPD Action Plan PDF | September 2020 | ![]() |
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RFDS SE Alcohol & Other Drugs Outreach | May 2021 | ![]() |
n/a |
Outback Eye Service Clinic View Ophthalmology Referral Options | November 2023 | ![]() |
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WNSW LHD Templates
Template |
Location |
Date Effective |
Best Practice |
Medical Director |
LHD Geriatric Medicine Clinic Referral Form | Western NSW LHD | March 2019 | ![]() |
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LHD Lung Cancer Fast Track Clinical Referral | Western NSW LHD | May 2019 | ![]() |
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LHD Planned Care for Better Health | Western NSW LHD | November 2022 | ![]() |
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LHD Alcohol & Other Drugs Service | Western NSW LHD | May 2021 | ![]() |
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LHD Movement Disorders Coordinator | Western NSW LHD | July 2022 | ![]() |
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LHD Bathurst High-Risk Foot Referral | Bathurst | November 2019 | ![]() |
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Bathurst After Hours Medical Service - Patient Form for RACF Visits | Bathurst | February 2018 | ![]() |
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LHD Dubbo Public Eye Clinic View Ophthalmology Referral Options | Dubbo | November 2023 | ![]() |
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PRP Imaging Referral | Dubbo | April 2020 | ![]() |
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LHD Dubbo Fast Track Resp. Outpatient Clinic | Dubbo | January 2020 | ![]() |
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LHD Dubbo Respiratory LFT Referral | Dubbo | January 2020 | ![]() |
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Diabetes Shared Care Plan Template (Dubbo Diabetes Project) | Dubbo | June 2017 | ![]() |
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Dubbo After Hours Medical Service - Patient Form for RACF Visits | Dubbo | February 2018 | ![]() |
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LHD Dubbo High-Risk Foot Service Referral Form | Dubbo | October 2018 | ![]() |
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LHD Dubbo Neurophysiology Ambulatory Care | Dubbo | July 2018 | ![]() |
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Lourdes Hospital Hydrotherapy Referral | Dubbo | July 2018 | ![]() |
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Lourdes Hospital Pre-Admission Referral | Dubbo | July 2018 | ![]() |
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Orana Mall Sleep Study Referral Form | Dubbo | October 2019 | ![]() |
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LHD Dubbo Neurophysiology Study Referral | Dubbo | May 2020 | ![]() |
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LHD Dubbo Direct Access Scopes | Dubbo | May 2020 | ![]() |
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LHD Dubbo HITH PICC | Dubbo | June 2020 | ![]() |
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LHD Dubbo Orthopaedic | Dubbo | October 2020 | ![]() |
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LHD Orange Referral positive FBOT for NBCSP | Orange | January 2020 | ![]() |
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Orange Liver Clinic Referral | Orange | August 2020 | ![]() |
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LHD Orange Colonoscopy Referral for Positive Faecal Occult Blood Test | Orange | February 2018 | ![]() |
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General Paediatrics at Orange Paediatric Clinic Referral | Orange | April 2020 | ![]() |
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LHD Orange Iron Fusion | Orange | October 2020 | ![]() |
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LHD Orange Ambulatory Care | Orange | October 2020 | ![]() |
Far West LHD Templates
Other Referral Forms
Template |
Patient Referral Form |
GP Referral Instructions |
Pink Angels | PATIENT REFERRAL FORM | GP REFERRAL INSTRUCTIONS |
Guide Dogs NSW/ACT | PATIENT REFERRAL FORM | |
Referral form for Group Allied Health Services under Medicare |
Patient Referral Form |