New referral
Subject: Pharmacotherapy referral, [patient initials], DOB [DD/MM/YYYY] Dear dosing pharmacist, I would like to refer [patient initials] to Priceline Pharmacy Sunshine Marketplace for opioid dependence pharmacotherapy. Clinical summary - Indication: opioid dependence - Planned medicine class: [oral / long-acting injectable] - Planned starting dose: [dose] (induction) - SafeScript checked: [date] - Co-prescribed CNS depressants: [list OR "nil"] - Pregnancy: [yes / no / not applicable] Patient context - Languages: [English + other] - Vulnerability factors: [if any] I will issue the first prescription on the agreed start date. Please confirm capacity and proposed first-dose timing. Kind regards, [Prescriber name, AHPRA, clinic phone]