Disability Support Pension (DSP) – GP Support Letter Template
Patient Details:
- Name: John Smith
- Date of Birth: 12/03/1978
- Address: 123 Main Street, Anytown
- Centrelink Reference Number (CRN): 123456789
Treating Professional Details:
- Name: Dr. Jane Doe
- Qualification(s): MBBS, FRACGP
- Provider Number: 1234567A
- Practice Address: The Medical Clinic, 456 Oak Avenue, Anytown
- Contact Number: 03 9876 5432
- Email: jane.doe@medicalclinic.com.au
- Duration of Treatment: 5 years
Medical Conditions:
- Primary medical condition(s): Major Depressive Disorder, diagnosed 01/01/2018 by Dr. Smith (Psychiatrist).
- Secondary medical condition(s): Chronic back pain, diagnosed 01/06/2015.
Treatment History:
- Treatment approaches trialled: Multiple courses of antidepressants (Sertraline, Citalopram), psychotherapy, and regular physiotherapy for back pain.
- Treatment outcomes and adequacy: Partial response to antidepressants, with ongoing symptoms of low mood, fatigue, and anhedonia. Physiotherapy has provided some relief for back pain, but it remains a chronic issue.
- Reason further treatment unlikely to help: Despite optimal treatment, the patient's symptoms have not significantly improved, and further interventions are unlikely to yield substantial functional gains.
Functional Impact:
Patient experiences significant limitations in their ability to work due to persistent low mood, fatigue, and chronic pain. These symptoms impact their concentration, energy levels, and ability to interact socially, making it difficult to maintain employment.
- Mobility: No significant mobility difficulties.
- Communication: No significant communication difficulties.
- Social Interaction: Avoids social situations due to low mood and anxiety.
- Learning & Cognition: Difficulty concentrating and remembering information.
- Self-care: No significant self-care difficulties.
- Domestic Tasks: Requires assistance with some household chores.
- Financial & Administrative: Requires assistance managing bills.
Capacity for Work:
Based on my clinical assessment, it is my professional opinion that the patient’s condition results in a severe functional impairment, and they are unable to work or engage in education/training now or in the foreseeable future.
Prognosis:
Despite ongoing treatment, the patient’s condition has remained stable, and no improvement in functional capacity is expected within the next two years. Therefore, I certify that their condition is fully diagnosed, treated and stabilised.
Declaration:
I, Dr. Jane Doe, confirm that the information in this letter is accurate to the best of my knowledge and based on my clinical assessment.
Please contact me if further information is required.
Signature:
Date: 01/11/2024
Disability Support Pension (DSP) – GP Support Letter Template
Patient Details:
- Name: [patient full name] (Insert the full name of the patient. Only include if explicitly mentioned in transcript, contextual notes or clinical note; otherwise omit completely.)
- Date of Birth: [date of birth] (Insert in DD/MM/YYYY format. Only include if explicitly mentioned in transcript, contextual notes or clinical note; otherwise omit completely.)
- Address: [patient address] (Insert the patient’s current residential address. Only include if explicitly mentioned in transcript, contextual notes or clinical note; otherwise omit completely.)
- Centrelink Reference Number (CRN): [CRN] (Insert the Centrelink reference number if known. Only include if explicitly mentioned in transcript, contextual notes or clinical note; otherwise omit completely.)
Treating Professional Details:
- Name: [clinician full name] (Insert your full name. Only include if explicitly mentioned in transcript, contextual notes or clinical note; otherwise omit completely.)
- Qualification(s): [clinician qualifications] (Insert your relevant qualifications. Only include if explicitly mentioned in transcript, contextual notes or clinical note; otherwise omit completely.)
- Provider Number: [provider number] (Insert your Medicare provider number. Only include if explicitly mentioned in transcript, contextual notes or clinical note; otherwise omit completely.)
- Practice Address: [practice address] (Insert your full practice address. Only include if explicitly mentioned in transcript, contextual notes or clinical note; otherwise omit completely.)
- Contact Number: [contact number] (Insert your preferred contact number. Only include if explicitly mentioned in transcript, contextual notes or clinical note; otherwise omit completely.)
- Email: [email address] (Insert your professional email address. Only include if explicitly mentioned in transcript, contextual notes or clinical note; otherwise omit completely.)
- Duration of Treatment: [duration of treatment] (Insert how long you have treated the patient. Only include if explicitly mentioned in transcript, contextual notes or clinical note; otherwise omit completely.)
Medical Conditions:
- [primary medical condition(s)] (List all primary diagnosed conditions relevant to the patient’s DSP claim, including diagnosis date and diagnosing practitioner. Only include if explicitly mentioned in transcript, contextual notes or clinical note; otherwise omit completely.)
- [secondary medical condition(s)] (Include any secondary but relevant conditions contributing to the patient’s impairment. Only include if explicitly mentioned in transcript, contextual notes or clinical note; otherwise omit completely.)
Treatment History:
- [treatment approaches trialled] (Summarise treatment history including medications, allied health input, and referrals to specialists. Only include if explicitly mentioned in transcript, contextual notes or clinical note; otherwise omit completely.)
- [treatment outcomes and adequacy] (Explain response to treatment and confirm that reasonable treatments have been trialled or considered. Only include if explicitly mentioned in transcript, contextual notes or clinical note; otherwise omit completely.)
- [reason further treatment unlikely to help] (If applicable, include an explanation of why further treatment is not expected to improve function. Only include if explicitly mentioned in transcript, contextual notes or clinical note; otherwise omit completely.)
Functional Impact:
[functional summary] (Describe the impact of the patient’s condition on their ability to work or study. Use plain-language examples aligned to DSP impairment tables. Only include if explicitly mentioned in transcript, contextual notes or clinical note; otherwise omit completely.)
- Mobility: [mobility difficulties] (e.g., needs mobility aids, cannot walk more than 100m without rest. Only include if explicitly mentioned in transcript, contextual notes or clinical note; otherwise omit completely.)
- Communication: [communication difficulties] (e.g., difficulty understanding or expressing needs. Only include if explicitly mentioned in transcript, contextual notes or clinical note; otherwise omit completely.)
- Social Interaction: [social interaction limitations] (e.g., avoids social contact due to mental health. Only include if explicitly mentioned in transcript, contextual notes or clinical note; otherwise omit completely.)
- Learning & Cognition: [learning or cognitive issues] (e.g., poor memory, difficulty planning or concentrating. Only include if explicitly mentioned in transcript, contextual notes or clinical note; otherwise omit completely.)
- Self-care: [self-care difficulties] (e.g., needs help with hygiene or medication. Only include if explicitly mentioned in transcript, contextual notes or clinical note; otherwise omit completely.)
- Domestic Tasks: [domestic task limitations] (e.g., needs help with chores or meal preparation. Only include if explicitly mentioned in transcript, contextual notes or clinical note; otherwise omit completely.)
- Financial & Administrative: [admin/financial dependency] (e.g., requires assistance managing bills or appointments. Only include if explicitly mentioned in transcript, contextual notes or clinical note; otherwise omit completely.)
Capacity for Work:
[Insert patients capacity for work] (If clinicians states that the patient is not fit for work, write: "Based on my clinical assessment, it is my professional opinion that the patient’s condition results in a severe functional impairment, and they are unable to work or engage in education/training now or in the foreseeable future.")
Prognosis:
[Insert patients prognosis] (If clinician states that patient has had no improvement in functional capacity, insert: "Despite ongoing treatment, the patient’s condition has remained stable, and no improvement in functional capacity is expected within the next two years. Therefore, I certify that their condition is fully diagnosed, treated and stabilised.")
Declaration:
I, [clinician full name] (Insert your full name. Only include if explicitly mentioned in transcript, contextual notes or clinical note; otherwise omit completely), confirm that the information in this letter is accurate to the best of my knowledge and based on my clinical assessment.
Please contact me if further information is required.
Signature:
Date: [date] (Insert date the letter was signed. Only include if explicitly mentioned in transcript, contextual notes or clinical note; otherwise omit completely.)
(For each section, only include if explicitly mentioned in transcript or context, else omit section entirely. Never come up with your own patient details, assessment, plan, interventions, evaluation, or next steps—use only the transcript, contextual notes, or clinical note as reference for all information. If any information related to a placeholder has not been explicitly mentioned, do not state that the information has not been explicitly mentioned in your output; just leave the relevant placeholder or section out entirely. Use as many lines, paragraphs, or bullet points as needed to capture all relevant information from the transcript.)