Case Consference Template 2010

							                          <<Miscellaneous:Practice Letterhead>>
                        GP Multidisciplinary Case Conference
                                         Medicare Items
            Organising & Coordinating                                       Participating
              735 = 15min to 20min                                      747 = 15min to 20min
              739 = 20min to 40min                                      750 = 20min to 40min
                  743 = 40min+                                              758 = 40min+

Patient name: <<Patient Demographics:Full Name>>
Patient Address:                           Date of case conference: <<Date of case
<<Patient Demographics:Full Address>>      conference>>
Patient Contact (hm): <<Patient
Demographics:Phone (Home)>>                Role of GP: (coordinator/participant)
(mob): <<Patient Demographics:Phone        <<Role of GP in Case Conference>>
(Mobile)>>

Doctor details:                                    Patient consent obtained: <<Patient consent
<<Doctor:Full Details>>                            obtained>>

                                                   Copy of case conference record to patient file
                                                   and other participants: <<Copy of report to
                                                   other providers:>>

        Other Participants involved:                              Include family/carers involved
            (at least 2 aside from GP)                  (don't count towards the min 2 outisde participants)
1)                                                 4)
2)                                                 5)
3)                                                 6)

Diagnoses / Problems:

<<Clinical Details:History List>>

Issues needing discussion:


Goals / Management aims:


Plan:


Plan discussed with patient: <<Plan discussed Review date: <<Review Date>>
with patient>>




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