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Psychiatrist Form

DVA Referral Form (D0904 0425)

A downloadable Psychiatrist form for healthcare professionals.
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Specialty

Psychiatrist

Downloads

23 times

Type

Form

Last edited

7/24/2026

Created by

Jane Jones

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About this form

Used by psychiatrists, GPs, nurses, social workers, and allied health professionals to refer Department of Veterans’ Affairs clients for treatment or allied health services. It captures patient details, accepted disabilities, and clinical information to ensure appropriate and approved care under DVA funding. Heidi automatically pre-fills the form using information discussed during the consultation, streamlining referrals and reducing administrative work.

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Frequently asked questions

What is the purpose of the DVA Referral Form (D0904 0425) PDF?

The purpose of the DVA Referral Form (D0904 0425) is for health providers in Australia to refer Department of Veterans' Affairs clients for treatment or allied health services that do not require prior approval. It captures patient details, DVA card type, accepted disabilities, and clinical information to ensure the patient receives appropriate care under their DVA funding. The form is used for Gold Card holders (for all conditions) and White Card holders (for accepted disabilities only), streamlining referrals directly to a medical specialist or allied health provider.

Who uses the DVA Referral Form (D0904 0425) PDF?

As a referring health provider in Australia, such as a GP, psychiatrist, or other specialist, you use this form to refer Department of Veterans' Affairs clients for treatment. You complete the patient details, the condition to be treated, clinical history, and referral period. The treating allied health provider who receives the referral retains the completed form for their records and for potential DVA audit purposes. You are responsible for documenting the referral details, while the treating provider is responsible for verifying DVA eligibility.

What is included in a DVA Referral Form (D0904 0425) PDF?

The DVA Referral Form (D0904 0425) includes patient and provider details, referral information, and the patient's clinical context.

  • Referral type (specialist or allied health) and DVA card type (Gold or White)
  • Patient details: name, DVA file number, date of birth, address, and phone number
  • List of the patient's accepted disabilities
  • Referred-to provider's details: name, address, phone, and provider number
  • The specific condition to be treated
  • Residential aged care facility status, if applicable
  • Clinical details: relevant illnesses, injuries, and current medications
  • Period of referral, which may be indefinite for some specialist referrals
  • Referring provider's details: name, provider number, practice information, signature, and date

Common Problems of Completing DVA Referral Form (D0904 0425) PDFs

Card Type and Accepted Disabilities Mismatch

Verifying a patient's DVA entitlements before referring is a critical but often difficult step. For White Card holders, DVA will only fund treatment for their specific, accepted disabilities. If you refer a patient for a condition not on that list, the claim will be rejected and the referral is invalid. Confirming the patient's card type and cross-referencing their accepted disabilities list against the condition being treated requires careful administrative work, and any mismatch creates problems for both the patient and the receiving provider.

The Treatment Cycle Adds Referral Complexity

For allied health referrals, the process is governed by a Treatment Cycle of up to 12 sessions or one year. At the end of a cycle, the allied health provider must report back to the patient's usual GP before a new referral can be issued for a subsequent cycle. This creates a coordination challenge for you as the referring provider. You must be aware of any existing cycles and their end dates to ensure your new referral is clinically appropriate and correctly timed.

Prior Approval Confusion and the Wrong Form

A common point of confusion is determining whether a referral requires prior approval from DVA. This form is specifically for services that do not need prior approval. If approval is required, you must use a different form entirely (Form D1328). Making the wrong choice leads to using the incorrect form, which causes administrative rework and delays the patient's access to care. This distinction requires you to be clear on DVA's specific rules for the service being requested.

Benefits of Using Heidi to Auto-Fill DVA Referral Form (D0904 0425) PDFs

Entitlement Checks Done Before You Refer

You need to be certain a patient's referral is valid for their DVA status. Heidi surfaces the patient’s documented DVA card type, Gold or White, and their list of accepted disabilities directly from the administrative record. It then flags if the condition you are referring for falls outside the White Card entitlements, alerting you that a different approval process is needed. This gives you the information to confirm eligibility at the point of referral, not after a rejection.

Clinical Details Drafted From the Session

Instead of manually summarizing a patient's history, you can focus on the clinical conversation. Heidi pulls the current problem list, recent illnesses, injuries, and medication record from the patient's file to populate the clinical details section of the form. This provides the receiving provider with a clear, structured history as a starting point for their assessment. You review and confirm the output, ensuring the information accurately reflects the patient's situation before the form is finalized.

Treatment Cycle Tracking Built into the Referral

Knowing where a patient is in their allied health Treatment Cycle can be difficult to track. For allied health referrals, Heidi identifies if a cycle is in progress and surfaces the session count and cycle start date from the record. This helps you set the referral period to the correct remaining duration, preventing duplicate or invalid referrals and ensuring continuity of care. You get a clear view of the patient's current care plan without digging through past documents.

How to use this form

1

Auto-fill with Heidi

Click "Auto-fill Form with Heidi" to open the form in Heidi and complete the fields straight from your note, no copying and pasting.

2

Review and edit

Check the pre-filled details and make any changes before finalising the form.

3

Download or save

Download the completed form or save it directly into your patient records and workflows.

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