Get Closing The Gap Program Referral Form

The Closing The Gap Program Referral Form is essential for providing access to vital health services for Aboriginal and Torres Strait Islander patients. This guide will walk you through the process of filling out the form online effectively.

Follow the steps to complete the form accurately.

1. Use the ‘Get Form’ button to access the referral form and open it for editing.
2. Begin by selecting the patient's priority level by indicating 'Urgent' or 'Routine' based on their needs. Next, check the appropriate boxes to identify whether the patient identifies as Aboriginal and/or Torres Strait Islander.
3. In the 'Patient Details' section, enter the patient's surname, first name, date of birth, address, and phone number. Ensure that gender is specified by selecting 'Male' or 'Female.'
4. Provide the patient's Medicare number and its expiry date in the designated fields.
5. Fill in the 'GP Details' section by including the name, practice, and phone number of the general practitioner responsible for the patient's care.
6. Indicate the patient's chronic disease types by checking one or more boxes, including options like diabetes, cancer, or cardiovascular disease.
7. In the 'Care Coordinator' section, check the boxes for the services that can assist the patient in managing their chronic disease condition.
8. Outline any financial support requirements in the 'Supplementary Services' section, specifying what aids or assistance may be necessary for the patient's care.
9. Both the patient and the GP should sign and date the form in the respective signature sections at the end of the document.
10. After completing the form, ensure you save the changes. You can then download, print, or share the form as needed.

Complete the Closing The Gap Program Referral Form online today to ensure timely access to essential health services.