Austin & Peter MacCallum Cancer Centre Drug and 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'Patient Details' section. Enter the patient's surname, given names, preferred name, date of birth, pronouns, marital status, phone number, gender, email address, mobile number, residential address, and postal address if different.
3. Indicate if the patient is eligible for Medicare and provide their Medicare number if applicable. Also specify if they have private health cover and include the insured company details.
4. Complete the 'Clinical Details' section by specifying the department and doctor (if known), along with the reason for referral. Include any relevant medical history and current medications.
5. Fill in the 'Referring Doctor Details' with your surname, given name, practice name, provider number, contact information, and signature. Choose a referral validity period.
6. Once completed, sign the form and submit it via fax or email as indicated at the bottom of the document.

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