National Bowel Cancer Screening Program Forms
This page provides links to various forms that health professionals complete and send to the Register.
- Purpose of National Bowel Cancer Screening Program Forms
- Electronic Forms
- Manual (printer friendly) Forms
- Information Payment
- How to order paper forms
Purpose of National Bowel Cancer Screening Program Forms
The purpose of the National Bowel Cancer Screening Program (NBCSP) Forms is to provide information to the NBCSP Register about participants in the Program.Top of page
Electronic Forms
These forms can be downloaded, completed on your computer, saved and/or printed and submitted to the National Bowel Cancer Screening Register by selecting the "Submit" button on the form. These forms do not need to be sent by facsimile. If you wish to download a form to be sent to the National Bowel Cancer Screening Register by facsimile or by post, please use the manual versions of the forms. Links to download these forms appear under the heading Manual (Printer Friendly) Forms.System Requirements
You will require Adobe Reader (at least version 8.1.1) to be able to submit the forms electronically to the National Bowel Cancer Screening Register. The latest version of Adobe Reader can be downloaded free of charge from http://www.adobe.com/products/acrobat/readstep2.html.Smart Forms
Some sections of the electronic forms will only display after specific selections are made. For example, the Medicare Number format will display after the Medicare Number button is selected. Please do not print a blank copy of an electronic form to complete by hand because the information on the form will be incomplete. If you wish to download a form that you can complete by hand and send to the National Bowel Cancer Screening Register by fax or by post then go to the section headed Manual (printer friendly) Forms where there are links to the appropriate versions of the forms.Instructions for Accessing and use of Electronic Forms
Select the form you wish to use, complete the form on your computer, and submit the form by selecting the submit button on the form. Forms submitted electronically will be sent to the National Bowel Cancer Screening Register by a secure email transmission. Confirmation will be provided where a form has been submitted successfully. The confirmation includes a reference number that can be used to track the delivery of the form if necessary. You may print and/or save a copy of this confirmation if you wish.Links to electronic forms - ONLINE SUBMISSION ONLY
Please note: To complete a form by hand, you must use the Manual (Printer Friendly) forms. Some sections of the electronic forms will not print.Assessment Form - Referred for colonoscopy/Not referred for colonoscopy following a positive FOBT result
To be completed by general practitioners to provide information about consultations with Program participants who have received a positive FOBT result.
Colonoscopy Report
To be completed by colonoscopists to report the results of a colonoscopy for a Program participant with a positive FOBT result. This form also enables colonoscopists to report adverse events which occurred during the procedure or are known at the time of completing this form.
Procedure Report - Adverse Outcomes
To be completed by colonoscopists to report information about an adverse outcome for a procedure relating to diagnostic investigation of a Program participant who has received a positive FOBT result. This form is only used where that information has not already been included in the Colonoscopy Report.
Histopathology Report
To be completed by a Pathologist to report the histopathology results of a specimen from a Program participant with a positive FOBT result.
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Manual (Printer Friendly) Forms
Links to download a copy of the paper based forms are set out below. These forms should be used if you wish to download the form, complete it by hand and send it to the National Bowel Cancer Screening Register by facsimile. These forms cannot submitted electronically and must be sent to the Register by
- facsimile to 1800 115 062; or
- by post to The NBCS Program, Reply Paid 83061, Hobart, Tas, 7001
Links to manual forms
Payment Accounts Details for Service Provider Form (PDF 53 KB)This form is used by a Service Provider (e.g., a sole trader or employer) to nominate a bank account in order to receive payments for notification of information provided to the National Bowel Cancer Screening Program Register via other forms. All information payments will be made to the bank account nominated on this form. One Payment Accounts Details for Service Provider Form should be completed for each provider using the provider number for the location.
Assessment Form - Referred for colonoscopy/Not referred for colonoscopy following a positive FOBT result (PDF 135 KB)
A manual (printer friendly) version of the electronic form.
Colonoscopy Report (PDF 137 KB)
A manual (printer friendly) version of the electronic form.
Procedure Report - Adverse Outcomes (PDF 111 KB)
A manual (printer friendly) version of the electronic form.
Histopathology Report (PDF 131 KB)
A manual (printer friendly) version of the electronic form.
Information Payment
The following information payments will be made for each correctly completed form that provides information to the National Bowel Cancer Screening Register about the progress of a Program participant through the screening pathway following a positive FOBT result:- $14.30 (GST inclusive) for each Colonoscopy Report or Histopathology Report; and
- $7.70 (GST inclusive) for each GP Assessment Form or Adverse Outcomes Report.
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How to order paper forms
Contact the National Bowel Cancer Screening Information Line on 1800 118 868.Page currency, Latest update: 06 April, 2009