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.

MD TEMPLATE	FORM DESCRIPTION
INSTRUCTIONS
Download Form (Microsoft Word Document)	General Instructions for Downloading and Using Templates  Medical Director
HEALTH CHECKS / ASSESSMENTS
Save Form for Importing	Annual Health Assessment.  MBS Item Numbers 700, 702, 704, 706
Save Form for Importing	ATSI Adult Health Assessment.  MBS Item Number 710
Save Form for Importing	ATSI Child Health Assessment.  MBS Item Number 708
Save Form for Importing	ATSI Over 55 Health Assessment.  MBS Item Number 704
Save Form for Importing	Comprehensive Medical Assessment.  MBS Item Number 712
Save Form for Importing	45 - 49 Year Old Health Check.  MBS Item Number 717
Diabetes
	Type 2 Diabetes Risk Assessment Tool - MBS Item 713
	Type 2 Diabetes Risk Assessment Tool - MBS Item 713
Four Year Old Health Check
Save Form for Importing	Initial Child Health Assessment Tool (ICHAT)
Save Form for Importing	Healthy Kids - Assessment
Save Form for Importing	Healthy Kids - Recall Letter
Mental Health
Save Form for Importing	Health Assessment for People with an Intellectual Disability.  MBS Item Numbers 718, 719.
GP MANAGEMENT PLANS
Save Form for Importing	GP Management Plan.  MBS Item Number 721
Save Form for Importing	GP Management Plan & Team Care Arrangement. MBS Item Numbers 721 & 723
Save Form for Importing	GP Management Plan Review.  MBS Item Number 725
Asthma
Save Form for Importing	GP Management Plan - Asthma.
Childhood Disability
Save Form for Importing	GP Management Plan - Childhood Disability
Chronic Obstructive Pulmonary Disease
	Care Plan - Chronic Obstructive Pulmonary Disease
Coronary Heart Disease
Save Form for Importing	GP Management Plan - Coronary Heart Disease.
Diabetes
Save Form for Importing	GP Management Plan.  MBS Item Number 721 - Diabetes
Mental Health
Save Form for Importing	Better Access Mental Health Care Plan.  MBS Item Number 2710
Save Form for Importing	Mental Health Management Plan.  MBS Item Number 2710 & 2712
Save Form for Importing	GP Mental Health Care Plan.
	GP Mental Health Care Plan Review - MBS Item 2712
Save Form for Importing	GP Management Plan - Depression and Anxiety
Osteoarthritis
Save Form for Importing	GP Management Plan - Osteoarthritis.
Palliative Care
Save Form for Importing	GP Management Plan - Palliative Care.
TEAM CARE ARRANGEMENTS
Save Form for Importing	Team Care Arrangements.  MBS Item Number 723
Save Form for Importing	Team Care Arrangements Review.  MBS Item Number 727
Asthma
Save Form for Importing	Team Care Arrangements - Asthma
Coronary Heart Disease
Save Form for Importing	Team Care Arrangements - Coronary Heart Disease
Diabetes
Save Form for Importing	Team Care Arrangements.  MBS Item Number 723 - Diabetes
Mental Health
Save Form for Importing	Team Care Arrangements - Depression and Anxiety
Osteoarthritis
Save Form for Importing	Team Care Arrangements - Osteoarthritis
SERVICE INCENTIVE PAYMENTS
Diabetes
Save Form for Importing	Annual Cycle of Care - Diabetes
REFERRALS
Save Form for Importing	Allied Health Referral Form - Aboriginal Health Professionals (Wheatbelt Aboriginal Health Services)
Save Form for Importing	Allied Health Referral Form - Aged Care Assessment Team
Save Form for Importing	Allied Health Referral Form - Child Development Team (0 - 18 years)
Save Form for Importing	Allied Health Referral Form - General Referral
Save Form for Importing	Better Access Mental Health Referral (Initial & Repeat)
Save Form for Importing	Enhanced Primary Care (EPC) Program - Referral Form for Allied Health Services under Medicare.  MBS Item Number 731
Save Form for Importing	Enhanced Primary Care (EPC) Program - Referral Form for Dental Care under Medicare
Save Form for Importing	Northam Hospital - Colonoscopy / Endoscopy Referral Form
Save Form for Importing	Wheatbelt Drug and Alcohol Team (Holyoake) - Referral Form
Save Form for Importing	Wheatbelt GP Network - Allied Health Team
Save Form for Importing	Wheatbelt GP Network - Counselling Referral Form
RECALLS / REVIEWS
Save Form for Importing	Hypertension Review / Recall Letter. Specifically created for Prescribing Data for General Practice Demonstration Project (with Melita Jensen) but maybe used by all practices.
HOME MEDICINES REVIEW
Save Form for Importing	Home Medication Management Plan.  MBS Item Number 900
Save Form for Importing	Residential Medication Management Review Referral
Save Form for Importing	Home Medication Review Referral
WORKERS COMPENSATION & EMPLOYMENT
	Centrelink Medical Certificate
	WA Workers Compensation - Initial Certificate
	WA Workers Compensation - Progress
	WA Workers Compensation - Final Certificate