To Drs4Drs Tasmania – call record

This form is used to collect information for calls received by the Drs4Drs service Tasmania

Confidentiality and privacy rights explained to the caller
Contact type
Who is calling?
Time take to return call
Estimated call duration
Gender of person being discussed
Location of the person being discussed
Geographic profile
Practice type
Practice status
Are you an international medical graduate?
Presenting problem
Is there any concern about risk or harm or suicide
Does the person have a GP?
Other referrals/recommendations
Timeframe for Referral service – urgency
Will you or did you spend time organising follow up support for the person being discussed?
Please estimate the amount of time needed for this follow up
Do you have an agreed case management plan?