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Versions | Form popularity | Fillable & printable |
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2014 | 4.5 Satisfied (63 Votes) |
The form allows referrals to multiple centers including Sydney Dental Hospital, Westmead Centre for Oral Health, and John Hunter Hospital.
Essential patient details such as family name, given name, date of birth, and contact numbers must be provided.
The form includes an option to indicate if an interpreter is required for the patient.
Patients can indicate if they hold a Health Care Card (HCC) or Pensioner Concession Card (PCC), which may affect their eligibility for services.
There is a section dedicated to capturing significant medical history and any special requirements related to access or guardianship.
The form provides options for the reason for referral, including requests for opinions or management by a specialist.
Referrers are prompted to identify any enclosures such as radiographs or reports that accompany the referral.