Online Referral

    Referring Doctor Details


    GPPsychiatristOther







    Patient Details





    D.O.B:

    Expiry:

    Funding

    NOK / Emergency Contact

    Indication(s) for Referral

    Major depressive disorderGeneralised anxiety disorderObsessive-Compulsive disorderPost-traumatic stress disorder

    Clinical History

    Treatment History

    Has this patient had adequate trial of 2 or more classes of anti-depressants?
    YesNo

    Has this patient had Psychological therapy?
    YesNo

    Has this patient received rTMS previously?
    YesNo

    Safety Checks

    Does the patient have any of the following:
    History of seizures/epilepsyCould be PregnantCardiovascular diseaseAlcohol/Illicit Drugs addictionNeurological illness, neurosurgery, or serious head traumaImplanted stimulator, medical pump, or pacemakerAny metal in the brain, skull or elsewhere in the body

    Medicare eligibility for rTMS – a patient must meet the following criteria:

    • Be at least 18 years of age
    • Be diagnosed with major depressive episode
    • Have failed to receive satisfactory improvement for the major depressive episode despite the adequate trialling
    of at least two different classes of antidepressant medications in therapeutic and maximum tolerated dose, unless contraindicated
    • Have also undertaken psychological therapy unless inappropriate; and
    • Have not received rTMS treatment previously in either a public or private setting.