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admin@bundaberghearingaids.net.au 7 Takalvan Street, Bundy West
Bundaberghearingaids.net.au
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BUNDABERG HEARING AIDS AND TINNITUS TREATMENT CLINIC GP REFERRAL PAD

PLEASE BE SO KIND AS TO USE THIS REFERRAL FORM WHICH KEEPS US MEDICARE COMPLIANT.
A GP LETTER GENERALLY IS OF INSUFFICENT DETAIL AS AUDIOLOGISTS ARE UNABLE 
TO SELECT THEIR OWN TESTS UNDER MEDICARE RULES..  MANY THANKS FOR YOUR KIND ASSISTANCE.

MOST SERVICES ARE NOW BULK BILLED WITH THIS REFERRAL PAD . Marked Services are not Bulk Billed and have no Medicare Rebate generally.  Restrictioins apply to some services like OAE’s.   Medicare or Hearing Service Program guidelines for Bulk Billing and Subsidised Services for eligible Pensioners and Veterans will apply.  Tests may be excluded if not relevant, or ineligible for Bulk Billing.  Other funding sources such as NDIS, SELF, DVA, HSP, WORKCOVER AND PRIVATE INSURANCE MAY APPLY.  ITEM 82318 includes A Hearing test
AIR BONE SPEECH with an additional cochlear test.  These may include, Tinnitus Pitch Matching, MML, 
UCL, Weber, Sisi, Stenger, Tone Decay,  or speech tests like Ling 6, Quiksin, Speech Roll Over and more. 
 Item 82306 non determinate Audiology may also cover these if required.

	Patient Name:				DOB:					Referral Date:

	GP Name:				Provider #:				Practice:

	GP Signature:				Client Mobile:

OK TO FIT HEARING AIDS IF REQUIRED: 	YES		OR		DO NOT FIT HEARING AIDS		

Please circle YES to items required.     

1.	COMPREHENSIVE DIAGNOSTIC HEARING BATTERY - includes ALL tests below if appropriate 		YES
(EXTENDED RANGE AIR , BONE, SPEECH, TYMPANOMETRY, OTOACOUSTIC EMMISSIONS (OAE),		 Additional Cochlear test if required as explained above, non determinate audiology for additional
cochlear or speech tests if required and ABR, in case of significant sesorineural 
hearing asymmetry such as 2 Freq at 15dB or 1 at 20 dB or more)	
Medicare Items may include (82318 or 82315, 82324, 82300, 82332, 82306)				
2.	AUDITORY BRAINSTEM RESPONSE (ABR) for Exclusion of retrocochlear pathology (82300)		YES
3.	STANDARD ADULT HEARING TEST (5 YEARS AND OLDER) 82318/15, 82332, 82324			YES
      (Air, Bone, Speech, DPOAE and additonal cochlear test if required 
4.	CHILD HEARING TEST UNDER 5 YEARS  (ABR, OAE, TYMPS,) 82300, 82332, 82314			YES
also (AIR, BONE, SPEECH and Ling 6 test if not too young)  82318,82324				
5.	HEARING AID ASSESSMENT/TRIAL/RENTAL– INCLUDES COMPREHENSIVE BATTERY #1		YES
6.	TINNITUS ASSESSMENT AND MANAGEMENT-  as per #1 and  ABR,TE and DP OAE’s  TRQ, DAS21
7.	OTOTOXICITY HEARING TESTING AND MONITORING as per #1					YES
8.	AUDITORY PROCESSING TEST PART 1 as per #1 plus ABR to rule out Auditory Neuropathy		YES	
9.	AUDITORY PROCESSING TEST PART 2 (CAPD and Memory Testing)	$350				YES
10.	EAR WAX REMOVAL VIA MICROSUCTION	 			$60 Pensioner/$120 Private 	YES	
11.	EMPLOYMENT HEARING TEST						$150          	            		YES

https://bundaberghearingaids.net.au/referral-form

	YES
															
	TInnitus Assessment (As per Extended Range Hearing test plus ABR DASS 21 & TRQ)  			YES			,		
Ear Wax Removal Microsuction (includes Tymps if GP referred)	
BB if done under Care plan referral with proper referral form and Audiologist visit ticked.		YES
	
	Auditory Processing Testing - Must be performed across 2 days for Medicare compliance)		YES

Part1 Diagnostics  BB ALL Extended Air , BONE, SPEECH, , OAE & ABR TO RULE OUT NEUROPATHY) 			Part 2 Auditory Processing and Memory testing (Over 7 years)   $300
									
Additional Comments or Tests Required:

Please attach any additional information that may assist the audiologist in providing the best care for the patient

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