FOR REFERRING DOCTORS
Test Request Forms | Fees | Medicare
ELECTRONIC REQUEST FORM
RTF Electronic Referral Templates for your Practice Management software
BEST PRACTICE USERS
From April 2022 the Best Practice monthly update will automatically include our form called Ipswich Hearts Cardiac Test Request Form:
- From the main Bp Premier screen, click the Best Practice Premier Word Processor Icon icon or select Utilities > Word processor from the menu.
- Select Templates > Edit template. The Word Processor templates screen is displayed.
- Select the All option and tick Include all States to view all custom and system templates available for all Australian practices.
MEDICAL DIRECTOR USERS
Available in the templates section of Medical Director in the letter writer, it is called: Ipswich Hearts Cardiac Test Request Form.
GENIE
Available for download for Genie practices on version 9.3.9 and above:
1. Within Genie Client, navigate to Special > Software Updates
2. Click into the Forms tab and expand out Radiology Request Templates
3. Tick the box beside QLD Ipswich Hearts Cardiac Testing and click Import 1 Item and Save when prompted, then click OK.
This request form will now be available for sites to use when raising a new radiology request, under the template drop down menu.
EDITABLE &/ PRINTABLE PDF REQUEST FORM
REFERRAL PADS
For referring Doctors who prefer to hand write on pre-printed referral pads.
REQUEST FOR REFERRAL PADS
Please complete your practices details:
FEES
REQUEST FOR FEE SCHEDULE
Please complete your practices details:
MEDICARE & CARDIAC TESTS
The Australian Government stipulate when a test is claimable through Medicare based on:
- Patients symptoms and/or
- Clinical history and/or
- Family history and
- How often the patient has had the same test.
MEDICARE BENEFITS SCHEDULE (MBS)
REPEAT ECHO REQUEST
Medicare stipulate that a baseline echo can be claimed every 2 years with any Medical Practitioner being able to request. Please see below the relevant MBS item numbers from Medicare which detail when a repeat echo can be requested within 2 years of a baseline echo:
Item Number | Clinical Indication | Who Can Request |
|---|---|---|
55127 | For the investigation of known valvular dysfunction | Specialist or Consultant Physician
|
55128 | For the investigation of known valvular dysfunction | Medical practitioner (other than a specialist or consultant physician) located in Modified Monash 3,4,5,6 or 7 |
55129 | (a) valvular dysfunction is not the primary issue for the patient (although it may be the secondary issue) and
(b) the service is for the investigation of any of the following:
(i) symptoms or signs of cardiac failure
(ii) suspected or known ventricular hypertrophy or dysfunction
(iii) pulmonary hypertension
(iv) aortic, thrombotic, embolic disease or pericardial disease (excluding isolated pericardial effusion or pericarditis)
(v) heart tumour
(vi) structural heart disease
(vii) other rare indications | Specialist or Consultation Physician |
55132 | (a) is for the investigation of a patient who:
(i) is under 17 years of age or
(ii) has complex congenital heart disease and
(b) is performed by a specialist or consultant physician practising in the speciality of cardiology | Any Medical Practitioner |
55133 |
(a) is for the investigation of a patient who:
(i) has an isolated pericardial effusion or pericarditis
(ii) has a normal baseline study, and has commenced medication for non-cardiac purposes that has cardiotoxic side effects and is a pharmaceutical benefit for the writing of a prescription for the supply of which under that Part an echocardiogram is required | Any Medical Practitioner
|
55134 | For the investigation of rare cardiac pathologies | Specialist or Consultant Physician |