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Non-Emer­gency Patient Trans­port (NEPT) Book­ing Request Form

This form is to be used to request Non-Emer­gency Patient Trans­port (NEPT) by ProMED Tas­ma­nia for patients who are med­ical­ly sta­ble and require trans­port between health­care facil­i­ties, to and from appoint­ments, or for dis­charge home. Please com­plete all manda­to­ry fields to ensure your book­ing can be processed with­out delay.

If you have any ques­tions about com­plet­ing this form, please con­tact us by phone on 1300 303 419 or by email at nept@​promedtas.​com.​au

If the book­ing request is from a health facil­i­ty with access to a Form 10A — Patient Assess­ment Record, please com­plete this doc­u­ment and email it to nept@​promedtas.​com.​au 

Patient Details

Please provide the Hospital/Facility ID where the patient is being treated or referred (if applicable).

Please provide First Name, Middle Name (if applicable), and Surname.

Please provide using the format DD/MM/YYYY.

Please provide Street Address, Suburb, State, and Postcode.

Please provide the Patient's Phone Number, including area code (e.g. 03 6234 5678 or 0412 345 678).

Patient Representative

If booking for yourself, please provide your own details.

If booking for yourself, please provide your own details.

If booking for yourself, please provide your own details.

If booking for yourself, please select "Self (Patient)".

Transport Details

Please provide the full name of the referring doctor, clinician, or healthcare facility (if applicable).

Please provide Facility Name (if applicable), Street Address, Suburb, State, and Postcode.

Please provide using the format DD/MM/YYYY HH:MM.

Please provide Facility Name (if applicable), Street Address, Suburb, State, and Postcode.

Please provide using the format DD/MM/YYYY HH:MM.

Select "Yes" if transport is required for the return journey, or "No" if only a one-way trip is needed.

Please provide the expected appointment length. If unsure, provide your best estimate or check with the treating facility.

Please provide the reason transport is required (e.g. specialist appointment, medical procedure, treatment, discharge).

Assessment of Patient

Please provide using the format DD/MM/YYYY HH:MM.

Please provide where the assessment was undertaken (e.g. home, facility, or clinic name).

A clinician is a Registered Medical Practitioner, Registered Nurse or Registered Paramedic.

Please provide First Name and Surname.

Please provide the patient's primary diagnosis or condition.

Does the patient have any relevant comorbidities/medical conditions: 

Please list any other comorbidities/medical conditions not already listed.

Please indicate whether the patient's BGL is within their normal range.

Please provide using the format DD/MM/YYYY HH:MM.

Please provide the patient's latest BGL reading.

Specify any existing conditions that may predispose patient to harm: 

Please list any other exsisting conditions not already listed.

Specify details of any current care or treatments commenced prior to transport: 

Please list any other care or treatment not already listed.

Please indicate the patient's oxygen delivery method.

Please provide the patient's current oxygen flow rate in litres per minute (LPM).

Please list the medications being provided, including name, dosage, and frequency.

Please provide the insertion site and gauge of the cannula (e.g. left forearm, 20G).

Please indicate whether the patient is post-operative (Yes/No).

Please provide using the format DD/MM/YYYY.

Please indicate whether the patient is receiving regular pain relief (Yes/No).

Please list the medications being provided, including name, dosage, and frequency.

Please indicate whether pain relief is likely to be required during transport (Yes/No).

Please list the medications required, including name, dosage, and frequency.

Please indicate whether the patient is clinically stable and unlikely to deteriorate during transport (Yes/No).

Clinical Observations/Vital Signs

Vital Signs
Date/Time (24hr)Resp RateSpO2PulseBPTempPain (0-10)Alert and Cooperative?

Please provide the patient's most recent vital signs, including date and time recorded

Please provide any comments on variations or trends in the patient's vital signs (e.g. recent fluctuations/changes). Leave blank if not applicable.

Equipment Requirements

Please indicate whether the patient exhibits signs or symptoms suggestive of an infectious disease that could be transmitted through airborne particles.

Select "Yes" if the patient requires a stretcher for transport, or "No" if they can be transported by wheelchair or walking.

Select "Yes" if the patient requires a wheelchair for transport, or "No" if they can walk independently or require a stretcher.

List any additional equipment needed (e.g. oxygen, cardiac monitor, bariatric equipment). Leave blank if not applicable.

Please list any relevant instructions from the patient's Advanced Care Directive (e.g. resuscitation preferences, treatment limitations, substitute decision-maker). Leave blank if not applicable or unknown.

List any specific needs or considerations (e.g. toileting assistance for long trips, interpreter required, hearing aids, fall risk precautions, dietary restrictions). Leave blank if not applicable.