Health Practitioner Delegation and Written Order Template
A health practitioner delegation and written order template for NDIS high intensity daily personal activities. The delegating health practitioner completes and signs it. The provider files a separate copy for each participant and each support type.
What is inside:
- Order type: written order or documented phone order
- Participant details and the high intensity support type covered
- Delegating practitioner details, including Ahpra or professional association number
- Delegation confirmations: assessment, care plan endorsement, worker training and authorisation
- Prescriber written order for subcutaneous injections: medication, dose, route, frequency and injection sites
- Table of trained workers authorised under the delegation
- Practitioner signature, delegation valid until date and any conditions
- Provider filing record and review reminder
Good to know: the form states that sub-delegation is prohibited and each worker needs their own current authorisation. State and territory medicines laws may add requirements for injections.
- Reviewed against the current NDIS Rules, Practice Standards and Commission guidance
- Editable DOCX with a placeholder legend, so you enter your details once
- Instant download
These templates are general information, not legal advice. No template can guarantee registration or audit outcomes.
Buying more than one template? This one is also in
On its own this template is $24.99. Each pack below includes it, plus the rest of the set.
Add-on modules and other packs
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