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Referral Forms

We are constantly adding to and updating this list. If there is something you would like to see included, please email us at practicesupport@ddwmphn.com.au and let us know.


Chronic Disease Referral Form (Formerly RPHS) Referred patients must utilise all other funding options prior to using Chronic Disease Program funding.
DVA Request This form should be used to: • request prior approval from DVA, where necessary, for treatment services and the supply of rehabilitation appliances; • refer directly to another provider where prior approval from DVA is not required; • request patient transport for travel to treatment services.
ITC Referral Form - CCSS Integrated Team Care (ITC) General Practitioner Referral Form - Care Coordination and Supplementary Services (CCSS) Program
ITC Referral Form - Transport and Practical Assistance Integrated Team Care (ITC) Referral Form - Transport and Practical Assistance
MHSRRA Referral Form Access to Mental Health Services Rural and Remote Area Referral (MHSRRA)
PFAS Claim Form Blood Tests Per- and Poly-fluoroalkyl Substances (PFAS) Claim Form - Pre and Post Blood Tests
PFAS Claim Form Mental Health Per- and Poly-fluoroalkyl Substances (PFAS) Claim Form - Psychological Therapies & Mental Health Services
PMHC MDS Mental Health Care Services This form is for new patients from 1 July 2017
Toowoomba Diabetes Service Referral Form Toowoomba Diabetes Service Referral Form - Credentialed Diabetes Educator (CDE) services, for the self-management of Diabetes
West Moreton - Medical Director - Referral Form Instructions Instructions for importing templates into Medical Director (PDF)
West Moreton - Best Practice - Referral Form instructions These are instructions for importing templates into Best Practice (PDF)
West Moreton - Best Practice Referral Form Click to Download Best Practice Outpatient Referral Form (RTF)
West Moreton - Medical Director Outpatient Referral Form Click to download Referral Form Template(RTF)
West Moreton - ZedMed Outpatient Referral Form Click here to download Zedmed Outpatient Referral Form (RTF)
Zostavax Vaccine Referral Form Zostavax Vaccine Referral Form
Latest Announcements

Latest announcements

Apply today - Expressions of Interest Reference Group for the Darling Downs & West Moreton PHN Health Needs Assessment

September 21, 2017

Darling Downs and West Moreton PHN are seeking Expression's of Interest for our HNA Reference Group. This is part of…
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Joint Media Release - PHN provides extra drug and alcohol treatment funding for Chinchilla, Kingaroy and Dalby

September 20, 2017

An extra $293,000 in Drug and Alcohol Treatment services (DATS) will go to the areas of Chinchilla, Kingaroy and Dalby…
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Expression of Interest - My Health for Life - Darling Downs Region

September 18, 2017

Expression of Interest - My Health for Life - Darling Downs Region. Applications close COB Monday 2 October 2017
Read more

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