WCHN Proposed Changes to Outpatient Re-appointment Form

17 October 2019

The Public Service Association (PSA) has been advised the Women’s and Children’s Health Network (WCHN) is proposing to update the outpatient re-appointment form.

WCHN has stated the aim of the update is to comply with the requirements of the new SA Health Medicare Billing Directive for Outpatient Services.

Please find the current form here,
And the proposed new form here.

WCHN has advised the PSA the following processes will be required of staff working with the new form:

  •  Tick the form to advise Consultants whether a valid named referral or unnamed referral has been received for the patient;
  •  Complete their name and sign the bottom of the form as the employee completing the form.


For patients who elect to have a private outpatient service, administrative staff will also be required to:

  •  Strike out the non-applicable option on the form (i.e. Medicare Bulk Billed (no patient charges) for this service*/ Incur an out-of-pocket charge (gap) at 15% of the CMBS) – i.e. where a clinic bulk bills (majority of clinics), the second option will be crossed out;
  •  Obtain the patient’s or legally authorised representative’s signature and date


NB: Administrative staff are already getting patients, or their legally authorised representative, to sign a Medicare Benefits assignment form (DB4) for private outpatient services so now two signatures on two forms will be required.

Please contact PSA by Friday 18 November 2019 with your feedback if you have concerns or questions around the proposed changes.