PA Hospital HIMS Health Informatics Unit Forms Management - Form MSH016 Form MSH016 - breastscreen q 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by affixing your identification label at the top of the form. If using an E-Form, complete the URN and personal details including family name, given names, address, date of birth, and sex.
3. Fill in the facility information and ensure to direct your referral to the CENTRAL REFERRAL HUB. Include your contact phone number and email for follow-up.
4. In the Client Details section, provide comprehensive information such as Medicare number, pension number, indigenous status, country of birth, language preferences, and whether an interpreter is required.
5. Indicate the GP or consultant's details including their name, address, phone number, and fax number. Attach any necessary medical summaries or discharge documents.
6. Tick all applicable management requirements for the client’s condition from the provided options.
7. Select a preferred site for service from the listed locations.
8. Complete relevant medical information and list any other services involved in the client's care.
9. Finally, have the referrer sign off on the form by providing their name, signature, designation, contact number, and referral date before submission.

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