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Allied health services referral form

Referral Form for Individual Allied Health Services under 2025

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4.2 out of 5

53 votes

The document is a referral form for General Practitioners (GPs) to refer patients with chronic medical conditions and complex care needs to individual Allied Health Services under Medicare. It outlines the necessary details for GPs, including patient information, allied health provider specifics, and the number of services required. Eligible patients can access up to five allied health services per calendar year, and GPs are encouraged to attach relevant care plans. The form also emphasizes the requirement for allied health providers to report back to the GP after services.

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Click ‘Get Form’ to open the Referral Form for Individual Allied Health Services in our editor.
Begin by filling out the GP details section. Enter your Provider Number, Name, Address, and Postcode accurately.
Next, complete the Patient details section. Input the Medicare Number, Patient’s reference number, First Name, Surname, Date of Birth (DOB), Address, and Postcode.
In the Allied Health Provider (AHP) section, specify the name or type of AHP you are referring the patient to along with their Address and Postcode.
For Referral details, indicate the number of services required next to each relevant AHP type listed. Remember that eligible patients can access a maximum of 5 allied health services per calendar year.
Finally, ensure that you sign and date the form in the Referring General Practitioner’s signature section before submitting it.

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Versions	Form popularity	Fillable & printable
2010	4.2 Satisfied (53 Votes)
2009	4.7 Satisfied (59 Votes)
2006	4 Satisfied (28 Votes)
2005	4.4 Satisfied (39 Votes)

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What is a referral form for?

The purpose of a referral form is to provide detailed information about the referred individual or business and the reason for the referral, which helps to ensure that the referral is appropriate and that the referred party receives the necessary information and support.

What is a referral letter for allied health?

Within allied health practice, a referral statement or referral letter, helps clinicians collaborate and provide patient-centric care. It serves as a conduit for seamless communication between allied health professionals, offering invaluable insights into a clients needs, goals, and progress.

Who fills out the referral form?

Your GP will now complete our digital referral process.

How to fill a patient referral form?

How to Write a Medical Referral Letter with Examples Header with Practice Details and Date. Recipients Information and Greeting. Patient Identification and Reason for Referral. Clinical Details. Investigations and Test Results. Reason for Referral and Request for Action. Patient Contact Information and Enclosures.