Requests for forms, letters, plans or Medication Agreements
Medication Forms or letters
Medication Agreement Form ($35)
Medication Letter for Customs & overseas travel;
Webster Packs instructions.
Letter to support request for compounding of a medication($35)
We provide a DECD Medication Agreement Form for you to complete all the necessary details (medication, strength, dose, time and method of administration, etc.)
The DECD Form we send to you is a modified version of the South Australian DECD Medication Agreement Form. This allows you to detail all the information needed for Medications as easily as possible.
Once completed, please send it back to us by email.
The medication name, strength, dose and time and method of administration should be detailed, including
The form of the medication e.g., liquid, capsules, tablets, topical (such as cream or ointment), inhaler, injection etc.;
amount of the medication for each dose e.g., 1.5 tablets, 5 ml, 2 drops, etc.
The time specified should allow up to 30 minutes before or after the nominated time.
Some fields have drop-down boxes, and others auto-populate to avoid tedious repetition.
If more than four medications must be detailed, please submit a second form to include the additional medications (however, your doctor may wish to have an appointment if more than four medications are involved).
For Medication Agreement Forms, please also complete all the Guardian/Parent sections to provide all the details.
Other forms, letters or reports
Requests for a Letter, form or brief report for another purpose, that are additional to letters generally provided in relation to a consultation, and that can be done without further consultation ($35 per document)
Examples may include requests for a support or explanatory letter, or a brief report for school, NDIS or another third party etc. Please provide details about the purpose of the form or letter and any needed information to allow your doctor to fully understand and quickly provide your request without further consultation.
Authorisation for early dispensing of a script repeat ($35)
Please detail the medication’s name, strength and dose so the doctor can check against their records.
Seizure Management Plan ($35)
Seizure Management Plan with Midazolam ($35)
Medication Purpose Form for the NDIS ($40)
How to make the Request
Please use the Request Form below to ensure that you provide all the needed information.
You may instead send an email to us to make the request as long as you provide all the needed information in the one email.
Please advise us of the date on which you need the document, or if it is urgent. There is an additional charge where the letter or form is requested within the next 5 business days or your provider’s next clinic day, whichever is later.
If about medications, we then send you the DECD Medication Agreement Form.s
We send you an invoice.
Once the invoice is paid, your doctor then completes and sends the document to you by email.
For Medication Agreements, the doctor checks the medication details you have detailed in the DECDs Form and then signs the form and sends it to you.
For the Customs/Travel Letter or Webster Pack Instructions, the doctor checks and uses the medication details you have provided in the DECDS Form to complete the letter.
Your doctor may require an appointment to complete the request, and we will email an offer or phone to organise this. If an appointment is needed, your provider may adjust the fee to accommodate the Request Fee that has already been paid. Whether the doctor requires an appointment or adjusts the associated fee is a matter for their discretion.
The fee must be paid to proceed with the Request.
Fees
$40 for a Medication Purpose Form or more complex letter or form.
$35 for any other Request for an Agreement, Plan or letter, including one or more medications.
An additional $40 if you request the document be provided within 5 business days or your provider’s next clinic, whichever is later.
If, instead of an email, posting, or faxing of a paper form or letter is requested, an additional charge of $15.00 will apply.
An additional $35 may be billed if you require additional administrative work, time, and communications for your Request. Please allow us to manage your request as efficiently and cost-effectively as possible by carefully reading the provided information, submitting the form, and working with us through our streamlined procedure.
Please phone to make the payment, or email a copy of your bank’s remittance advice to show the payment. We will send a receipt.
The fee is billed to cover the costs of the significant work involved in processing and completing the Request, including both administrative and medical work. An appointment may be required if the doctor feels the Request involves more complexity.
Do I need my Specialist to complete the required form or letter?
Your GP can normally complete these Medication Forms and Letters. Check with them to see if they are happy to do so.
Parents can generally complete the following:
Medication Agreement Forms for as-needed or occasional pain relief such as Panadol or Nurofen, Melatonin, antiseizure medications (not Midazolam), Fluoxetine, asthma medications, Clonidine and other non-Schedule 8 Medications.
Seizure Management Plans (not requiring administration of Midazolam).
Medication Agreement Forms: Your Specialist or GP must complete the medical section of the Form for Schedule 8 controlled drugs such as Opioids, Stimulants, Oxygen, Insulin, and regular pain relief.
Seizure Management Plans: The Specialist Paediatrician, Neurologist, or Neurology Nurse must complete a Plan involving the use of Midazolam. These specialists should also complete a Plan not requiring Midazolam where the seizure type requires a non-standard first aid response, where a parent or guardian requires support to complete this form, or a private school or centre requires this.