To be completed by referring GP: 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by ticking the relevant box indicating whether the patient has an EPC Multidisciplinary Care Plan or a GP Management Plan. This is crucial for determining eligibility for Medicare rebates.
3. Fill in the GP details section, including Provider Number, Name, Address, and Postcode. Ensure accuracy as this information is essential for processing.
4. Enter the Patient details, including Medicare Number, Patient’s reference number, First Name, Surname, Address, and Postcode. This ensures that all patient information is correctly linked to the referral.
5. Specify the Allied Health Professional (AHP) being referred to by entering their Name and Address. This helps streamline communication between healthcare providers.
6. In the Referral details section, indicate the number of services required next to each AHP type. Use a separate copy of the form for different services if necessary.
7. Finally, ensure that you sign and date the form at the bottom as a confirmation of referral before submitting it.

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