Electronic Templates


IMPORTANT - PLEASE READ
The Templates on this page are for use with the relevant computer software.  Please choose to save the documents rather than opening them.  Opening the documents in Microsoft Word rather than your medical software can damage the document's functionality.

Should you require assistance in downloading and using these forms, please contact member services on  (08) 9621 1530  (08) 9621 1530 or email memberservices@wheatbelt.com.au.

INSTRUCTIONS

Download Form
(Microsoft Word Document)

General Instructions for Downloading and Using Templates - Medical Director


HEALTH CHECKS / ASSESSMENTS

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Annual Health Assessment.  MBS Item Numbers 700, 702, 704, 706

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ATSI Adult Health Assessment.  MBS Item Number 710

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ATSI Child Health Assessment.  MBS Item Number 708

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ATSI Over 55 Health Assessment.  MBS Item Number 704

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Comprehensive Medical Assessment.  MBS Item Number 712

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45 - 49 Year Old Health Check.  MBS Item Number 717

    Four Year Old Health Check

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Initial Child Health Assessment Tool (ICHAT)

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Healthy Kids - Assessment

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Healthy Kids - Recall Letter

    Mental Health

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Health Assessment for People with an Intellectual Disability. 
MBS Item Numbers 718, 719.


GP MANAGEMENT PLANS

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GP Management Plan.  MBS Item Number 721

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GP Management Plan & Team Care Arrangement. MBS Item Numbers 721 & 723

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GP Management Plan Review.  MBS Item Number 725

    Asthma

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GP Management Plan - Asthma.

    Childhood Disability

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GP Management Plan - Childhood Disability

    Coronary Heart Disease

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GP Management Plan - Coronary Heart Disease.

    Diabetes

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GP Management Plan.  MBS Item Number 721 - Diabetes

    Mental Health

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Better Access Mental Health Care Plan.  MBS Item Number 2710

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GP Management Plan.  MBS Item Number 2710 - Mental Health

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GP Mental Health Care Plan.

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GP Management Plan - Depression and Anxiety

    Osteoarthritis

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GP Management Plan - Osteoarthritis.

    Palliative Care

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GP Management Plan - Palliative Care.


TEAM CARE ARRANGEMENTS

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Team Care Arrangements.  MBS Item Number 723

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Team Care Arrangements Review.  MBS Item Number 727

    Asthma

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Team Care Arrangements - Asthma

    Coronary Heart Disease

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Team Care Arrangements - Coronary Heart Disease

    Diabetes

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Team Care Arrangements.  MBS Item Number 723 - Diabetes

    Mental Health

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Team Care Arrangements - Depression and Anxiety

    Osteoarthritis

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Team Care Arrangements - Osteoarthritis


SERVICE INCENTIVE PAYMENTS

    Diabetes

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Annual Cycle of Care - Diabetes


REFERRALS

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Allied Health Referral Form - Aboriginal Health Professionals

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Allied Health Referral Form - Aged Care Assessment Team

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Allied Health Referral Form - Child Development Team (0 - 18 years)

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Allied Health Referral Form - General Referral

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Better Access Mental Health Referral (Initial & Repeat)

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Wheatbelt GP Network - Allied Health Team

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Enhanced Primary Care (EPC) Program - Referral Form for Allied Health Services under Medicare.  MBS Item Number 731

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Enhanced Primary Care (EPC) Program - Referral Form for Dental Care under Medicare

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Physiotherapy - Wheatbelt GP Network

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Wheatbelt Support Services - Referral Form


HOME MEDICINES REVIEW

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Home Medication Management Plan.  MBS Item Number 900

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Residential Medication Management Review Referral 

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Home Medication Review Referral