Get the free ACT Health Consent Referral Assessment Form IMPACT Program

*25035* * 2 5 0 3 5 Name: * Date of Birth: ACT Health Consent, Referral & Assessment Form URN: IMPACT Program Or affix patient label IMPACT Program Phone: 1800 211 274 Fax: (02) 6244 3770 Eligibility:

How to fill out act health consent referral

How to fill out an ACT health consent referral:

1. Start by obtaining the ACT health consent referral form. This form is typically available online on the official website of the ACT Health department or can be obtained from your healthcare provider.
2. Begin filling out the referral form by entering your personal information accurately. This includes your full name, date of birth, contact details, and address.
3. Next, provide information about your healthcare provider or the person referring you. This may include their name, clinic or organization name, contact information, and their provider number if applicable.
4. Indicate the reason for the referral in the appropriate section. Detail the specific healthcare services or specialty you are seeking assistance with.
5. Provide any relevant medical history or additional information that may assist the healthcare provider in understanding your condition or situation. This can include previous diagnoses, ongoing treatments, medications, allergies, or any other pertinent details.
6. If you have a preferred healthcare provider or specialist, you can write their name or provide their details in the form. However, if you do not have a preference, you can leave this section blank.
7. Consider indicating any specific language or communication requirements you may have. This will help ensure that appropriate support services, such as interpreters or translators, are arranged for your consultations.
8. If the referral is urgent or time-sensitive, make sure to mark it accordingly on the form. This will prioritize your case and may expedite the scheduling of appointments or consultations.
9. Carefully review the completed form to ensure all information is accurate and complete. Double-check for any errors or missing details before submitting it.

Who needs an ACT health consent referral?

1. Individuals who require specialized healthcare services in the Australian Capital Territory (ACT) may need an ACT health consent referral. This referral is typically required for accessing certain medical specialists, diagnostic tests, or specialized treatments.
2. Patients who have been advised by their primary healthcare provider, such as a general practitioner, to seek additional medical evaluation or treatment from a specialist may need an ACT health consent referral. It serves as a formal request for the specialist to assess the patient's condition and provide further recommendations or interventions.
3. Individuals who wish to access public health services in the ACT may also require an ACT health consent referral. This referral helps healthcare providers determine the appropriate level of care and prioritize patients based on medical need.

It is important to note that the specific requirements for an ACT health consent referral may vary depending on the healthcare provider, medical specialty, or service sought. It is advisable to consult with your primary healthcare provider or contact the relevant department within ACT Health to ensure you meet the necessary referral criteria.

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