PATIENT ELIGIBILITY

Who is eligible to be referred to providers under PAHS?
•	Health Care Card Holders
•	Pensioners or
•	Patients on a LOW income who would not otherwise be able to access a local service
If patient doesn’t satisfy one of these criteria, please refer using MBS or a private referral.
	Who should NOT be referred to providers under PAHS?
•	Patients who can afford to pay for a private service 
•	Patients with Private Health Cover
•	In-patients
•	Workers Compensation or Third Party cases
•	Department of Veterans Affairs patients (DVA)

HOW TO REFER
•	All patients must have a PRIORITY ALLIED HEALTH SERVICES referral form (current version) and satisfy the eligibility criteria. Self-referrals can be accepted. Please complete all sections.
•	Allied Health Professionals (AHPs) and practice nurses are able to refer patients to appropriate PAHS services. The patient’s regular GP must be notified and included in correspondence between AHPs. 
•	Patients are eligible for only one PRIORITY ALLIED HEALTH SERVICES referral, per Allied Health Service, in a 12-month period, except in extenuating circumstances. 

TO MAKE AN APPOINTMENT

PATIENTS NEED TO CONTACT THE PROVIDER TO BOOK THEIR APPOINTMENTS. 

PATIENTS SHOULD NOTIFY THE PROVIDER THAT THEY HAVE A PAHS/HealthWISE REFERRAL FORM.
•	This referral will cover the actual session cost. There is no direct cost to the patient.
•	Patients are eligible to receive up to 6 sessions per PAHS referral – Number determined by treatment plan.
•	Any additional materials or items provided will be at the patient’s own expense, unless otherwise arranged.

ELIGIBILITY CRITERIA
<<Eligibility Criteria>>
NOTE: Referrals under DVA, Workers Compensation and Third Party accident cases are ineligible for treatment under this program.

PATIENT DETAILS	
<<Ethnicity>>	
  Date: <<Miscellaneous:Date (short)>>
Language/s other than English spoken at home: _______________________________	
Name: <<Patient Demographics:Full Name>>  Date of Birth: <<Patient Demographics:DOB>>          Age: <<Patient Demographics:Age>>
Address: <<Patient Demographics:Address>>                                                                      Phone: <<Patient Demographics:Phone (Home)>>
Alternative contact details: <<Patient Demographics:Phone (Mobile)>>                                                Date: <<Miscellaneous:Date (short)>>
Referring Person Name: _____________________________ Organisation:________________________________              
Usual GP (if different to above) <<Usual GP if different from above>>Medical Practice Name: <<Practice:Name>>
NOTE: If available, please forward a copy of GPMP or TCA and/or recent pathology with referral, with patient’s permission. 
REASON FOR REFERRAL - Please describe concerns to be addressed by this referral.
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

PATIENT CONSENT (must be signed at time of referral)
I understand that personal information regarding the reason for my referral may be shared with other care providers such as HealthWISE and their Allied Health providers. Any information held is strictly confidential and I give permission for these health professionals to access this information solely for the purpose of this referral.
Patient signature_______________________________________________________________________________     Date____/____/____ 

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