If the condition is an emergency or immediately life threatening please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
Hepatitis B – Assessment and referral services are available -please refer to Sexual health and BBV Service
Hepatitis B - Treatment - please complete named referral to Infectious Diseases
Hepatitis C - Refer to Ipswich sexual health and BBV service if tested positive for Hepatitis C Virus all further specialist involvement will be managed by this service.
Mirena IUD – Removal of Mirena IUD is provided at this service. For the routine insertion of Mirena®/progesterone releasing IUD please refer to True Relationships and Reproductive Health (formerly known as Family Planning Queensland).
Patient's Demographic Details
- Full name (including aliases)
- Date and country of birth
- Residential and postal address including whether patient resides at an aged care facility
- Telephone contact number/s – home, mobile and alternative
- Medicare number (where eligible)
- Name of the parent or caregiver (if appropriate)
- Name of delegate and contact details (Department of Corrective Services)
- Preferred language and interpreter requirements
- Identifies as Aboriginal and/or Torres Strait Islander
- Any special needs, access requirements and/or disability relevant to the referral
Referring Practitioner Details
- Full name
- Full address
- Contact details – telephone, fax, email
- Provider number
- Date of referral
- Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner
Relevant clinical information about the condition
- Presenting symptoms (evolution and duration)
- Physical findings
- Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
- All conservative options that have been pursued unsuccessfully prior to referral
- Body mass index (BMI)
- Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
- Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
- Current medications and dosages
- Drug allergies
- Alcohol, tobacco and other drugs use
Reason for request
- To establish a diagnosis
- For treatment or intervention
- For advice and management
- For specialist to take over management
- Reassurance for GP/second opinion
- For a specified test/investigation the GP can't order, or the patient can't afford or access
- Reassurance for the patient/family
- For other reason (e.g. rapidly accelerating disease progression)
- Clinical judgement indicates a referral for specialist review is necessary
- Impact on employment
- Impact on education
- Impact on home
- Impact on activities of daily living functioning – low/medium/high
- Impact on ability to care for others
- Impact on personal frailty or safety
- Identifies as Aboriginal and/or Torres Strait Islander
Other relevant information
- Willingness to have surgery (where surgery is a likely intervention)
- Choice to be treated as a public or private patient
- Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
Conditions seen at Sexual health and BBV service
Please note that patients do not need a referral to access sexual health service. Walk ins and self referrals are welcome.
This is not a CPC guideline. West Moreton staff please select 'CPC not applicable'
Sexually transmitted infections:
- Genital Herpes
- Genital Warts
- Mycoplasma Genitalium
- Trichomonas Vaginalis
- Pelvic Inflammatory Disease (PID)
- Bacterial Vaginosis
- Hepatitis C - see ‘Are you referring to the right service’
- Hepatitis B – see ‘Are you referring to the right service’
Other services offered
- Needle & Syringe Program
- Screening for sexually transmitted infections
- PreP – Pre-exposure Prophylaxis for people at risk of contracting HIV
- PEP - Post-exposure Prophylaxis for people who have had an at risk event and are at risk of contracting HIV
- Opportunistic Cervical Screening
- Opportunistic Contraception including EC, oral, injectable and implant. For Mirena IUD see ‘Are you referring to the right service’ above
- All services are free and confidential, we accept walk in and appointment-based
The clinical team
- Advanced Practice Nurses & Nurse Practitioner
- Aboriginal and Torres Strait Advanced Health Workers
- Medical Officer
- NSP Program Officer
- Please advise us if you are unable to attend your appointment and we will be happy to reschedule.
- It is important to bring your current Medicare card with you on each visit.
- If you are not eligible for a Medicare card, any costs will be discussed with you at your visit.
- A Medicare card is required to obtain prescriptions that are subsidised by the Pharmaceutical Benefits Scheme (PBS) and supplied through the pharmacy. A co-payment may be required.
Out of catchment
West Moreton Health is responsible for providing a public health service to people who reside within its catchment area. To appropriately manage demand for service we do not accept referrals from outside this catchment area. If your patient does live outside the West Moreton Health area and it is deemed socially or clinically necessary for their care to be received in the West Moreton Health Service, inclusion of information regarding their particular medical and/or social factors will assist with the triaging of your referral.
To provide feedback about contents on this website or general referral questions please email WM-CPC@health.qld.gov.au or phone 3413 7402.