HIGH NEED DISCRETIONARY FUND REPORTING FORM For Period 01 Jan 2020 – 30 June 2020
General Practice Name: _______________________________________________
Funds received for the Period
$
(GST excl.)
Funds utilised for the Period
$
(GST excl.)
Funds remaining at 30 June 2020
$
(GST excl.)
Number of Patients Assisted: How Were Patients Assisted:
Signed by: ___________________________
Date:____________________
SKIN SURGERY FUND REPORTING FORM For Period 01 Jan 2020 – 30 June 2020
General Practice Name: _______________________________________________
Funds received for the Period
$
(GST excl.)
Funds utilised for the Period
$
(GST excl.)
Funds remaining at 30 June 2020
$
(GST excl.)
Number of Patients Assisted: How Were Patients Assisted:
Signed by: ___________________________
Date:____________________
PALLIATIVE CARE REPORTING FORM For Period 01 Jan 2020 – 30 June 2020
General Practice Name: _______________________________________________
Funds received for the Period
$
(GST excl.)
Funds utilised for the Period
$
(GST excl.)
Funds remaining at 30 June 2020
$
(GST excl.)
$
(GST excl.)
Number of Patients who have Received Subsidised Care
Type of Services Funded for Patients
Average Cost per Patient Average number of Consults per patient Number of Patients who have Died at Home Percentage of Patients with a Care Plan
Signed by: ___________________________
Date:___________________