Referral Forms & Templates

On this page you find all our referral forms and templates. If you can’t see one you would like please contact us.

Please take care when downloading templates into clinical software. Do not open Best Practice or Medical Director forms outside of your clinical software, as this will corrupt the file. Download the Importing Templates into Clinical Software Tip Sheet if you are unsure.

Please select which HealthWISE service you are needing a Referral Form or template for:

Mental Health

Changes to Mental Health Referral Pathway (PRIMA)

The referral pathway for PHN-Commissioned Mental Health Services is changing. HNECC PHN will move forward with the Australian Government’s transition to a Head to Health Statewide Intake and Assessment Hub & Spoke Model. In this new Hub & Spoke model, the Intake and Assessment (IAR) will occur centrally, and the referrals will be managed locally by a service funded by each PHN.

Due to this change, from 1 October 2024 referrals will be directed to the statewide commissioned Intake and Assessment Hub to be assessed before the Referral Spoke service allocates the referral to local mental health services. Referrals to PRIMA will cease and will no longer be managed by HealthWISE. It is important to note that all PHN commissioned mental health services will continue to be delivered by the existing local providers.

For further information please referer to the Head to Health website or contact the service provider on 1800 595 212.

View the letter from the PHN.

NSW

Referral forms and information sheets for New England North West NSW

Mental Health, Client Referral and Consent Form

Indigenous Mental Health, Client Referral and Consent Form

Residential Aged Care

Natural Disasters Self Referral Form and Information Sheet

Suicide Prevention Initiative - Aftercare (SPI)

QLD

Referral forms for Darling Downs West Moreton QLD -

Lived Experience Program Information Sheet

Clinical Care Co-ordination Program Information Sheet

Natural Disasters Self Referral Form and Information Sheet

Aboriginal Health

Aboriginal Health Access

NSW Integrated Team Care (ITC)

Indigenous Mental Health, Client Referral and Consent Form

Priority Allied Health Services (PAHS)

Please read guidelines before downloading referral documents.

EASTERN- Armidale, Glen Innes, Guyra, Inverell, Kootingal/Nundle, Manilla, Qurindi, Tenterfield, Walcha, Tingha

WESTERN - Barraba, Bingarra, Boggabri, Boomi, Gunnedah, Moree, Mungindi, Narrabri, Warialda, Wee Waa

Allied Health Referral Forms

Referral Form for Individual Allied Health Services under Medicare for patients with a chronic medical condition and complex care needs

Eating Disorder Care Plan

Referral Forms & Templates

Please select which HealthWISE service you are needing a Referral Form or template for:

Mental Health

Changes to Mental Health Referral Pathway (PRIMA)​

NSW

Referral forms and information sheets for New England North West NSW

Mental Health, Client Referral and Consent Form

Indigenous Mental Health, Client Referral and Consent Form

Residential Aged Care

Natural Disasters Self Referral Form and Information Sheet

Suicide Prevention Initiative - Aftercare (SPI)

QLD

Referral forms for Darling Downs West Moreton QLD -

Lived Experience Program Information Sheet

Clinical Care Co-ordination Program Information Sheet

Natural Disasters Self Referral Form and Information Sheet

Aboriginal Health

Aboriginal Health Access

NSW Integrated Team Care (ITC)

Indigenous Mental Health, Client Referral and Consent Form

Priority Allied Health Services (PAHS)​

Please read guidelines before downloading referral documents.

EASTERN- Armidale, Glen Innes, Guyra, Inverell, Kootingal/Nundle, Manilla, Qurindi, Tenterfield, Walcha, Tingha

WESTERN - Barraba, Bingarra, Boggabri, Boomi, Gunnedah, Moree, Mungindi, Narrabri, Warialda, Wee Waa

Allied Health Referral Forms​

Referral Form for Individual Allied Health Services under Medicare for patients with a chronic medical condition and complex care needs

Eating Disorder Care Plan

Changes to Mental Health Referral Pathway (PRIMA)

Priority Allied Health Services (PAHS)

Allied Health Referral Forms