Appendix 3 - Removal from Waiting List Letter

(Choose the appropriate option)

has been removed from the elective surgery waiting list at , as the patient

-

no longer requires treatment

seeking/treated elsewhere

treated by another surgeon

refused 2 dates for surgery

could not be contacted

patient not available within timeframe

requests removal

deceased

If you have any concerns or require further information about the removal of your patient‘s name from the waiting list, please contact the Surgical Bookings Officer on < > between 9am to 4 pm Monday to Friday.

Yours sincerely

Appendix 4 – Reclassification of Clinical Priority form

ACT Health Re-classification of Clinical Priority Form	Complete details or affix label URN: Surname: Given name: DOB: Gender:
Date:
Patient:
Date of Clinical Review:
Original Clinical Priority Category:
New Clinical Priority Category:
Clinical reason for re-classification
Authorising Doctor (or Nominated Officer): Print Name: Signature: Designation:

Appendix 5 – Notification to patient of Registration on the waiting list

Patient ID:

Dear

I am writing to confirm that your request for elective surgery has been received on for a surgical procedure under the care of .

To assist in your preparation for surgery, you are required to complete the enclosed Patient Health Questionnaire (PHQ). Please return the questionnaire within 5 working days. You will not be placed on the Elective Surgery Waiting List until this form is returned.

Return the questionnaire in the reply paid envelope provided

or

email to: CWLS@act.gov.au

• 
  Please note that some free email providers scan emails for targeted advertising. This is not a breach of your privacy, although the PHQ is sent back at your own risk.
  

Your health is our priority and our staff are available to assist. If you have any questions or require assistance in completing the Patient Health Questionnaire, please do not hesitate to contact the Central Wait List team on the number below.

Yours sincerely

Central Wait List Team

Territory Wide Surgical Services

ACT Health

Tel: (02) 6205 1122

Appendix 6 – Urgency Category outside National Guidelines

Patient ID:

Dear Dr

A Request for Admission (RFA) form for has been received by the central Wait List team on .

It is noted that the clinical priority urgency category indicated on the RFA is not in line with the accepted National Elective Surgery Urgency Category Guidelines and no clinically verifiable justification for the change has been provided.

As stated in the Waiting Time and Elective Surgery Access Policy 2016, a clinically verifiable rationale must be documented on the RFA form if you have assigned the patient to a different clinical urgency category.

The RFA has been processed and the patient added to the Wait List under the clinical priority urgency category in line with the National Elective Surgery Urgency Category Guidelines. If this category is not correct, please complete the attached reclassification form with the required documentation and return to the central Wait List team in the enclosed reply paid envelope.

Thank you for your cooperation.

Yours sincerely

Central Wait List Team

Territory Wide Surgical Services

ACT Health

Tel: (02) 6205 1122