Specific
Item
MBS Service
Minutes
Benefit
training
Code
> 20min
2700
$69.00
No MHST
GP Mental Health
> 40min
2701
$101.55
Treatment Plan
GP MENTAL HEALTH
> 20min
2715
$87.60
preparation
MHST
trained
> 40min
2717
$129.00
TREATMENT PLAN
Review of plan
any
any
2712
$69.00
MH consultation
any
any
2713
$69.00
GP name and contact:
Name: _________________________
Phone: (____) ____________________
Date of birth: ____/___/____________
Address: ________________________
Patient agrees to service
________________________
Carer name: _____________________
Carer phone: (____) _______________
Presenting Complaint:
Background:
Mental State Examination done
Medications:
Alcohol/Benzodiazepines/Drug use:
Allergies:
K-10 Distress Scale
PHQ-9
(Rate from 1-5 as below)
Patient Health Questionnaire (Rate from 0-3)
In the last 30 days about how often did you feel…
In the last two weeks how often have you had the following?
1 Little interest or pleasure in doing things
_____
1 ...tired out for no good reason?
____
2 Feeling down, depressed or hopeless
_____
2 ...nervous?
____
3 Trouble falling or staying asleep or sleeping
3 ...so nervous that nothing could
too much
_____
calm you down?
____
4 Feeling tired or having little energy
_____
4 ...hopeless?
____
5 Poor appetite or little energy
_____
5 ...restless or fidgety?
____
6 Feeling bad about yourself (a failure or let
6 ...so restless you could not sit still?
____
down self/others)
_____
7 ...depressed?
____
7 Trouble concentrating on things, such as
8 ...that everything was an effort?
____
reading or TV
_____
9 ...so sad that nothing could
8 Moving or speaking so slowly others noticed
cheer you up?
____
or the opposite– being fidgety or restless
_____
10...worthless?
____
9 Thoughts that you would be better off dead
K-10 SCORE: ___
or hurting yourself
_____
PHQ-9 SCORE:
_____
Scoring:
Interpretation:
Interpretation:
Scoring:
1 = none of the time
2 = a little of the time
<20 normal distress
0 = not at all
< 4 minimal
5-14 mild
3 = some of the time
20-24 mild distress
1 = several days
4 = most of the time
25-30 moderate distress
2 = more than half the days
15-19 moderate
20-27 severe
5 = all of the time
30-50 severe distress
3 = nearly every day
Provisional Diagnosis:
Patient Goals:
In crisis/acute suicidality: Contact or refer to the local acute care team or to emergency.
Treatments:
Referrals (if required):
Pharmacotherapy
Internet CBT
Education
Psychologist
Psychiatrist
Acute Care Team
Internet-based CBT (iCBT) is available for depression & various anxiety disorders. GPs can prescribe Internet CBT, register at .au. iCBT includes psychoeducation.
Set review date:
Other plan:
Review of Mental Health Treatment Plan (Item 2712, $69.00, 1-6 months after Mental Health Plan created, up to twice in 12 months)
Review Date:
Agrees to review
K-10 score at review:
Review patient goals (met / unmet)
Further psychoeducation and plan: