Generic TCA Notes (Team Care Arrangement) Item 723

TEAM CARE ARRANGEMENTS - MBS ITEM No. 723 Patient’s Name: [Enter patient’s full legal name as recorded in medical records.] Date of Birth: [Enter patient’s date of birth in DD/MM/YYYY format.] Contact Details: [Enter patient’s full address, including street, suburb, and postcode.] Medicare or Private Health Insurance Details: [Enter patient’s Medicare number with reference number or private health insurance details.] Details of Patient’s Usual GP: [Enter the full name of the patient’s regular general practitioner.] [Enter the GP’s clinic name and full address.] Details of Patient’s Carer (if applicable): [Enter the full name and relationship of the patient’s carer if applicable. If no carer, omit this section.] Date of the last Care Plan / Team Care Arrangements (if done): [Enter the date of the last completed care plan or team care arrangement in DD/MM/YYYY format. If none, enter "Not applicable."] Other notes or comments relevant to the patient’s Team Care Arrangements: [Include any relevant clinical, administrative, or social notes related to the patient’s team care arrangement.] PAST MEDICAL HISTORY [List all significant past medical conditions, chronic illnesses, previous surgeries, and relevant medical history in a concise format.] FAMILY HISTORY [Provide details of family history related to hereditary or significant medical conditions that may impact the patient’s care.] MEDICATIONS [List all current medications, including name, dosage, frequency, and route of administration.] ALLERGIES [Specify any known allergies, including drug, food, or environmental allergens, along with the type of reaction experienced.] Goals - changes to be achieved [Describe the specific health goals the patient is expected to achieve, including short-term and long-term objectives.] Required treatments and services including patient actions [List all recommended treatments, services, and required patient actions. Ensure the list includes medical interventions, lifestyle modifications, and therapy sessions if relevant.] Specific arrangements for treatments/services (when, who, and contact details) [Provide details of scheduled appointments, healthcare providers involved, contact details, and any specific arrangements for ongoing treatments.] Copy of Team Care Arrangements offered to patient? [Enter "Yes" if a copy was provided to the patient; otherwise, enter "No."] Team Care Arrangements added to the patient’s records? [Enter "Yes" if the TCA was recorded in the patient’s file; otherwise, enter "No."] Copy / relevant parts of the Team Care Arrangements supplied to other providers? [Enter "Yes" if copies were sent to relevant healthcare providers; otherwise, enter "No."] Referral forms for Medicare allied health and dental care services completed? [Enter "Yes" if applicable referral forms were completed; otherwise, enter "No."] Date service was completed: [Enter the date the TCA service was finalized in DD/MM/YYYY format.] Proposed Review Date: [Enter the scheduled review date for the TCA, typically six months from completion.] "I have explained the steps and any costs involved, and the patient has agreed to proceed with the Team Care Arrangements." [Include statement if the patient agreed after an explanation; otherwise, do not include and state reason why based on transcript, context, clinical notes] "The patient also agrees to the involvement of other health providers and to share their clinical information [specify if with or without restrictions]." [Include statement if the patient consented; otherwise, do not include and state reason why based on transcript, context, clinical notes] GP’s Signature: [Enter GP’s full name.] Date: [Enter the date the GP signed the document in DD/MM/YYYY format.] (Never come up with your own patient details, assessment, plan, interventions, evaluation, and plan for continuing care - use only the transcript, contextual notes, or clinical note as a reference for the information to include in your note. If any information related