To find a specific template, press Ctrl+F and then type the keyword or topic you are looking for. If you don't find the topic the first time, try variations, different terms or fewer words. The templates provided by us are for your personal use only and must not be redistributed without permission. They have been tested with Version 1.8.4.642 of Best Practice and Version MD3.16 of Medical Director.

Many templates are available under the 'Supplied' section of most clinical software or searchable online from their respective organisations. If you have templates that you would like to share with your peers and/or have any enquiries please email the Practice Support and Digital Health team or phone them on 1300 986 991.

These templates have been specifically made to be important to your software or for use by printing out and handwriting in the form itself. The following documents can be downloaded to provide instructions on how to import these templates to your chosen program.

• Importing Templates into Best Practice from CESPHN Website
• Importing Templates into Medical Director from CESPHN Website

BP or MD templates should not be opened and viewed before downloading them into your practice software. An OPEN template, which is the MS-Word or PDF version of a template allows you to open and view the template before downloading it into your practice software. You can also use the Open version to complete assessments without going through the practice software.

The templates provided by CESPHN are for your personal use only and must not be redistributed without permission. They have been tested with the versions of Best Practice (1.8.4.642) and Medical Director (MD3.16).

All templates	Date as at	PDF	Word	Best Practice	Medical Director
List of all available templates by file type

Chronic Disease Management and Prevention	Date as at	PDF	Word	Best Practice	Medical Director
Accredited Exercise & Sports Science Practitioner - GP Referral Form			-	-	-
Accredited Practising Dietitian - GP Referral Form		-
Asthma - Action Plan template			-
Cancer - Breastscreen NSW Patient Referral Sheet
Cancer - Bowel Cancer Letter Template			-
COPD - Action Plan template (Lung Foundation)			-
Diabetes - AUSDRISK Tool			-
Diabetes - Basic Foot Assessment Checklist			-
Diabetes - NDSS Registration Form			-
40-49 year old Type 2 Diabetes Risk Evaluation			-
Get Healthy - GP Referral			-	Supplied in BP	Supplied in MD
GP Exercise Referral Scheme Referral		-
Health Assessment - 45-49 years check (Female)					Supplied in MD
Health Assessment - 45-49 years check (Male)					Supplied in MD
Optimised 75+ Health Assessment
Health Assessment - Refugee Health Assessment			-
Health Assessment - People with an Intellectual disability			-
Quitline - Referral Form			-
YMCA Brightside Referral - Morris Iemma ISC			-
Telehealth Staying Healthy, Living well - GP Referral Template	-		-
Think, Eat and Move (TEAM) Referral Form -13 to 17 year old
SLHD Podiatry Intake Form

Closing the Gap and Indigenous Health	Date as at	PDF	Word	Best Practice	Medical Director
Aboriginal Outreach Worker Referral Form			-	-	-
Allied Health Services Referral		-
CESPHN - Referral for Care Coordination			-	-	-
Closing the Gap Standard Specialist Referral		-
Closing the Gap Specialist Referral and Progress Notes		-
Health Assessment Child 0-15 (MBS ITEM 715)		-		Supplied in BP	Supplied in MD
Health Assessment Adult 15-54 (MBS ITEM 715)		-		Supplied in BP	Supplied in MD
Health Assessment Older Person 55+ (MBS ITEM 715)		-		Supplied in BP	Supplied in MD
Indigenous Health Incentive and PBS Co-payment Patient Registration/Consent		-
Indigenous Health Incentive and PBS Co-payment Patient Withdrawal			-	-	-

Digital Health (eHealth)	Date as at	PDF	Word	Best Practice	Medical Director
eHealth - Adult Registration Form			-
eHealth - Child Registration Form			-

Drug and Alcohol	Date as at	PDF	Word	Best Practice	Medical Director
Methadone consent for entry		-
Methadone letter to dosing point		-
Methadone transfer ID form		-
Methadone treatment agreement		-

General	Date as at	PDF	Word	Best Practice	Medical Director
Comcare - Certificate of Capacity			-
Comprehensive Medical Assessment (CMA) ACF & SLHD - 'My Wishes' Advance Care Plan
Schedule 1 - Medical Certificate		-
My Aged Care - Hospital Fax Referral Form	3 July 2017
National Centre Veterans Health Care Referral form	15 August 2019	-	-
COVID-19 Medicare Clearance	5 May 2020

GP Management Plan and TCA	Date as at	PDF	Word	Best Practice	Medical Director
Generic template - GPMP		-	document (57 KB)
Generic template - GPMP review		-
GPMP 721 – Asthma		-
GPMP 721 - Coronary heart disease (CHD)		-
GPMP 721 – Depression and Anxiety		-
GPMP 721 – Diabetes		-
GPMP 721 – Osteoarthritis		-
GPMP 721 – Osteoporosis		-
GPMP 721 - Palliative Care		-
GPMP & TCA - HIV			-
TCA 723 - AHP and Specialist Request Form		-
TCA 723 - Cover Letter		-
TCA 723 - Deny Letter (EPC Reverse Referral Requests)		-
TCA 723 - Asthma		-
TCA 723 - Coronary heart disease (CHD)		-
TCA 723 - Depression and Anxiety		-
TCA 723 - Diabetes		-
TCA 723 – Osteoarthritis		-
TCA 723 – Osteoporosis		-

Hospital - Calvary Hospital	Date as at	PDF	Word	Best Practice	Medical Director
Community Palliative Care Team (CPCT) - Admission Form		-	document (105 KB)	document (140 KB)
Community Palliative Care Team (CPCT) - Referral Form		-		document (156 KB)

Hospital - Canterbury Hospital	Date as at	PDF	Word	Best Practice	Medical Director
Endocrine/Maternity Clinic Referral form			-
Obstetric Referral Form	2 August 2018		-	document (140 KB)	-
Refugee Health Nurse Program		-

Hospital - Prince of Wales Hospital (POWH)	Date as at	PDF	Word	Best Practice	Medical Director
Diabetes Centre Referral		-
Eye Clinic - Patient Referral Form			-
The Outback Eye Service - Patient Referral Form			-	-	-
Outpatient Department GP eReferral		-	-
High Level and Complex Diabetic Foot Care Referral

Hospital - The Royal Hospital for Women (RHW)	Date as at	PDF	Word	Best Practice	Medical Director
Andrology Request Form - SEALS			-	-	-
Early Pregnancy Assessment Service (EPAS) Patient Referral			-	-	-
General Community Nursing Referral Form			-	-	-
Gynaecology Outpatients Referral		-
Maternal Fetal Medicine Referral			-	-	-
Patient Antenatal Referral Form			Refer online
Perinatal Mental Health Referral form			-
Referral Forms Combined (Antenatal, Maternal Fetal Medicine, EPAS & Physiotherapy)			-	-	-
Reproductive Medicine Referral Form			-	-	-

Hospital - Royal Prince Alfred Hospital (RPA)	Date as at	PDF	Word	Best Practice	Medical Director
RPA- Pathology Form for Combined First Trimester Screening blood collection
RPA - Fibroscan Only (pre HVC treatment) referral form			-
RPA - Remote Consultation Request for Initiation of Hepatitis C Treatment	25 July 2016		-
RPA Physiotherapy - Obstetric and Gynaecological Physiotherapy Referral	25 July 2017
RPA Women and Babies - Antenatal Thyroid Referral Form	4 June 2021		-	-	-
RPA Women and Babies - EPAS Referral Form	20 March 2015		-
RPA Women and Babies - First Antenatal Appointment Booking	Book online
RPA Women and Babies - Gynaecology Referral Form			-
RPA Women and Babies - HBV Referral Form			-
RPA Women and Babies - HCV Referral Form			-
RPA Women and Babies - Obstetric Referral			-
RPA Women and Babies - Psychosocial Referral Form			-
RPA Sexual Health GP Referral Form
RPA Women and Babies Ultrasound and Fetal Medicine Referral Form	August 2020
RPA Liver Tool Kit Referral Form	September 2021

Hospital - St George Hospital	Date as at	PDF	Word	Best Practice	Medical Director
Clinical Genetic Service Referral
Diabetes Education Centres Referral Form (St George and Sutherland)			-
Fibroscan Only (pre HVC treatment) referral			-
Outpatient GP Referral		-
Pulmonary Rehabilitation Program Entry Form			-
Remote Consultation Request for Initiation of Hepatitis C Treatment form			-
St George Swallow Centre - Request Oesophageal Function Studies		-
Waratah Clinic HIV Service - Outpatients Clinic Services Referral Form			-	-	-
St George Hospital Gynaecology Clinics referral form
St George Hospital Liver Tool Kit Referral Form	September 2021
St George and Sutherland hospitals: High risk foot services

Hospital - St Vincent's Hospital	Date as at	PDF	Word	Best Practice	Medical Director
Chronic Pain Services Referral		-
Department of Gastroenterology and Hepatology Referrals	Download forms from hospital's website
Diabetes Services Referral			-	-	-
FlexICare Referral Form			-	-	-
GP Referral to Psychogeriatric Service			-	-	-
Colonoscopy Referral Form (FOBT)
Non-Admitted Patient Clinic and Consultant Referral	How to refer

Hospital - The Sutherland Hospital	Date as at	PDF	Word	Best Practice	Medical Director
Outpatient GP Referral			-
Eye Clinic - GP Diabetic Retinopathy Screening Referral Form	5 July 2017	-
HealthOne Sutherland - Wound Clinic Referral Form
Respiratory Co-ordinated Care Program (RCCP) Referral Form			-	-	-
Southcare - Access and Referral Intake			-	-	-
Southcare - Authority to Apply Compression Therapy			-	-	-
Southcare - Community Medicataion Authorisation and Record			-	-	-
Southcare - Podiatry Referral Form
St George/Sutherland - Antenatal Referral & Booking Form			-		document (92 KB)
Sutherland Hospital Gynaecology Clinics referral form
Sutherland and St George hospitals: High risk foot services

Hospital - Sydney Children's Hospital	Date as at	PDF	Word	Best Practice	Medical Director
NSW Paediatric Palliative Care Referral Form			-	-	-

Hospital - Sydney Dental Hospital	Date as at	PDF	Word	Best Practice	Medical Director
Early Childhood Oral Health - Oral Health Advice Form			-	-	-
Oral Health Specialist Referral			-	-	-

Hospital - Sydney Eye Hospital	Date as at	PDF	Word	Best Practice	Medical Director
Sydney Eye Hospital - Eye Outpatient Referral
Sydney Hospital and Sydney Eye Hospital - Hand Clinic Referral Form			-	-	-

Local Health District - South Eastern Sydney Local Health District (SESLHD)	Date as at	PDF	Word	Best Practice	Medical Director
Family Care Cottage Referral Form			-	-	-
HIV Outreach Team - Client Intake & Registration Form			Refer online
Nafas Naqi Referral Form					document (97 KB) document (107 KB)
NSW Health - Out of Home Care Health Management Plan (NH606661)			-		document (92 KB)
NSW Health - Out of Home Care Primary Health Screen (2A) Under 1 yr (NH606662)			-		document (92 KB)
NSW Health - Out of Home Care Primary Health Screen (2A) 1-5 years (NH606663)			-		document (92 KB)
NSW Health - Out of Home Care Primary Health Screen (2A) 6-11 years (NH606664)			-		document (92 KB)
NSW Health - Out of Home Care Primary Health Screen (2A) 12-18 years (NH606665)			-		document (92 KB)
Renal & Hypertension Service Clinics - Referral Forms	Download forms from hospital's website
SESHLD - Connecting Care Referral Form Access and Referral Intake Form			-
St George/Sutherland - Antenatal Referral & Booking Form			-		document (92 KB)

Local Health District - Sydney Local Health District (SLHD)	Date as at	PDF	Word	Best Practice	Medical Director
Chris O'Brien Lifehouse - Referral Forms	Download forms from hospital's website
Collaborative Centre for Cardiometabolic Health in Psychosis (ccCHiP) Referral			-	-	-
Concord Burns Clinic - Telehealth Services Referral			-	-	-
Concord Hospital - Molecular Medicine DNA Request Form			-	-	-
Concord Hospital: Midwifery Group Practice GP Referral Form
Concord Hospital - Nuclear Medicine Referral			-	-	-
Healthy Homes and Neighbourhoods (HHAN) - Care Coordination Referral			-
SLHD - Aged Chronic Care and Rehabilitation Referral Form			-	-	-
SLHD - CHAIN Referral and Clinical Handover Form			-	-	-
SLHD - GP Incident Notification			-
SLHD - Pain Clinic Referral Form		-
SLHD - Palliative Care Home Support Packages (PEACH Program) Referral			-	-	-
SLHD - Peter Beumont Eating Disorders Service Referral Form	Download forms and information for referrers
SLHD - Podiatry Service Intake Form

Mental Health	Date as at	PDF	Word	Best Practice	Medical Director	Online
Mental health shared care checklist
PSS – GP Initial Referral for adults and children Mental Health Treatment Plan
PSS – GP Review Referral for adults and children and Mental Health Treatment Plan
Resources - Depression, Anxiety, and Stress Scales (DASS 21)
Resources - Health of the Nation Outcome Scale (HoNOS)	Refer online
Resources - Edinburgh Postnatal Depression Scale (EPDS)			-		document (21 KB)
Resources - Kessler Psychological Distress Scale (K10)			-
Resources - Kessler Psychological Distress Scale (K10+)		-	-
Services Referral - Black Dog Insitute Referral Forms for Clinics	Download forms from hospital's website
Services Referral - headspace Ashfield		-		-	-
Services Referral - headspace Bankstown			-	-	-
Services Referral - headspace Bondi Junction			-	-	-
Services Referral - headspace Camperdown			-	-	-
Services Referral - headspace Hurstville		-
Services Referral - headspace Miranda			-	-	-
GP - Eating Disorder Plan

Pain Management	Date as at	PDF	Word	Best Practice	Medical Director
Application for Authority to Prescribe a Schedule 8 Drug – Pain Management			-	-	-
Inner West Pain Centre - Referral Form	Refer online
SLHD Pain Clinic - Referral Form		-

Sexual Health and Viral Hepatitis	Date as at	PDF	Word	Best Practice	Medical Director
GSA - Generic 'Remote Consultation Request for Initiation of Hepatitis C Treatment' form
HIV GPMP and TCA			-
Patient Consent Form - s100 Highly Specialised Drug Prescriptions			-
RPA - Fibroscan Only (pre HVC treatment) referral form			-
RPA - Remote Consultation Request for Initiation of Hepatitis C Treatment			-
St George Hospital - Fibroscan Only (pre HVC treatment) referral			-
St George Hospital - Remote Consultation Request for Initiation of Hepatitis C Treatment form			-
Liver Tool Kit Project Letter

Women's Health	Date as at	PDF	Word	Best Practice	Medical Director
PAP Smear Recall Letter		-
Rockdale Women’s Health Clinic Referral Form
NDIS	Date as at	PDF	Word	Best Practice	Medical Director
Supporting NDIS Access 7 - 65 years		-	-