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Non-Emer­gency Patient Trans­port (NEPT) Book­ing Request

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

Booking Type

Who is making this booking? 

Please Note: 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

Patient's Full Name

Please provide the patient's first name, middle name (if applicable), and surname.

Please provide the patient's date of birth using the format DD/MM/YYYY.

Please provide the patient's phone number.

Patient's Residential Address

Please provide the patient's street address, suburb, state, and postcode.

Please provide the patients weight in kilograms (kg).

Transport Details

Patient Collection Location

Please provide the facility name & ward/room (if applicable), street address, suburb, state, and postcode.

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

Patient Destination Location

Please provide the facility name & ward/room (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).

Clinical & Care Needs

Please provide the patient's primary diagnosis or condition.

Please indicate whether the patient has any known allergies, sensitivities or adverse reactions, including to medications, foods, latex, or other substances. If yes, record each allergen and the type of reaction below. If none, please write N/A.

Patient's Cognitive Condition/s: 

Please specify any existing cognitive conditions that may predispose the patient to harm. Please select "Other" if not listed, and provide details in the box provided.

Please list any other exsisting conditions not already listed.

Patient's Comorbidities & Medical Conditions: 

Please specify any existing comorbidities/medical conditions. Please select "Other" if not listed, and provide details in the box provided.

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

Please provide the patient's mobility status. If you are not sure, choose "Not Sure", and we will confirm with you.

Please provide the patient's supplemental oxygen requirements. If you are not sure, choose "Not Sure", and we will confirm with you.

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.

Requester Details

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

Requester's Full Name

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.

Referrer Details

Referring Facility Details

Please provide the referring facility's name, street address, suburb, state, and postcode.

Referring Facility Contact Name

If booking for yourself, please provide your own details.

Please provide the referring facility's phone number.

Please provide the referring facility's email address.

Patient Details

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

Patient's Full Name

Please provide the patient's first name, middle name (if applicable), and surname.

Please provide the patient's date of birth using the format DD/MM/YYYY.

Please provide the patient's phone number.

Patient's Residential Address

Please provide the patient's street address, suburb, state, and postcode.

Please provide the patients weight in kilograms (kg).

Transport Details

Patient Collection Location

Please provide the facility name & ward/room (if applicable), street address, suburb, state, and postcode.

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

Patient Destination Location

Please provide the facility name & ward/room (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.

Please indicate whether the patient has any known allergies, sensitivities or adverse reactions, including to medications, foods, latex, or other substances. If yes, record each allergen and the type of reaction below. If none, please write N/A.

Patient's Cognitive Condition/s: 

Please specify any existing cognitive conditions that may predispose the patient to harm. Please select "Other" if not listed, and provide details in the box provided.

Please list any other exsisting conditions not already listed.

Patient's Comorbidities & Medical Conditions: 

Please specify any existing comorbidities/medical conditions. Please select "Other" if not listed, and provide details in the box provided.

Blood Glucose Level

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.

Advanced Care Directive (ACD)/Medical Orders for Life-Sustaining Treatment (MOLST)

Please list any relevant instructions from the patient's ACD/MOLST (e.g. resuscitation preferences, treatment limitations, substitute decision-maker).

Invasive Devices/Management

Does the patient have any invasive devices/management: 

Please list any other care or treatment not already listed.

Invasive Device - Access (CVAD/PIVC)

Please indicate the Central Venous Access Devices (CVAD) type.

Invasive Device Observations - Access Device (CVAD/PIVC)
Device TypeInsertion DateIntegrity of Device SiteDevice Secure & Intact (Y/N)Date/Time Last AccessedAnticipated Care Required/Other Information

Please list every applicable device (one device per row).

Invasive Device - Drain / Catheter (IDC/SPC/Drain)

Invasive Device Observations - Drain / Catheter (IDC/SPC/Drain)
Device TypeCurrent Drainage (mLs)Drainage Past 24hrs (mLs)Device Securement DetailsDevice Clamped (Y/N)Integrity of Device SiteAnticipated Care Required/Other Information

Please list every applicable device (one device per row).

Invasive Device - Other Devices (NGT/PEG/Trach)

Invasive Device Observations - Other Devices (NGT/PEG/Trach)
Device TypeInsertion DateIntegrity of Device SiteDevice Securement DetailsDate/Time Last Accessed/Flushed/SuctionedAnticipated Care Required/Other Information

Please list every applicable device (one device per row).

Vacuum Assisted Closure (VAC) Dressing

VAC Dressing Details
Date VAC CommencedDate of Last Dressing ChangeIntegrity of DressingIntegrity of VAC SystemPressure SettingsNo Active Management of VAC Required (Y/N)

Please list every applicable device (one device per row).

Oxygen Therapy

Please indicate the patient's oxygen delivery method.

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

Pain Relief (Analgesia)

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

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

Medications

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

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

Select Yes if the patient needs help taking, administering, or managing any medication during transport. Select No if the patient can manage their own medications independently.

Intravenous Therapy/Syringe Driver

Please list the additives in the intravenous therapy.

Intravenous Fluids / Elastomeric / Syringe Driver Details
Fluid TypeRateVolume Infused from Current Flask/SyringeVolume RemainingAdequate Volume for Transport (Y/N)TKVO/Pump/OffAnticipated Care Required/Other Information

Post-Operative Details

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

Please provide using the format DD/MM/YYYY.

Please indicate which operation/procedure was completed.

Clinical Observations/Vital Signs

Vital Signs 
Date/Time (24hr)Heart RateECG Rhythm (If Monitored)BPSpO2TempPain (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.

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

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

Equipment & Transfer Requirements

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.

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.

What Happens Next?

Once you submit this request, one of our patient transport clinicians will call you on the number you've given us to confirm the booking and ask a few short questions about the patient's health. We need those answers to make sure we send the right vehicle and the right crew — you don't need to have them ready now.

During business hours (Monday to Friday, 9.00am – 5.00pm), we will call you within 2 hours. If you submit this outside those hours or on a weekend, we'll call you on the next business day.

Your transport is not confirmed until we've spoken with you. If your transport is today or tomorrow, please call us on 1300 303 419 rather than waiting for us to call. And if you haven't heard from us when you expected to, call — we would always rather hear from you twice than miss you once.

Once you submit this request, our patient transport clinicians will review it and confirm the booking, or contact you if we need further clinical information or if the patient falls outside our scope of practice.

During business hours (Monday to Friday, 9.00am – 5.00pm), we will respond within 2 hours. If you submit this outside those hours or on a weekend, we'll respond on the next business day. Please allow at least 24 hours' notice where possible.

Sending this form does not confirm a booking. For same-day, urgent or after-hours bookings, call us on 1300 303 419 instead of waiting for a response.

Clinical Accuracy Confirmation

Clinical Accuracy Confirmation

Our eligibility criteria are listed on our Non-Emergency Patient Transport page. If you are unsure whether this patient is suitable, call us on 1300 303 419 before submitting.

Information Collection & Use Consent

Consent 

This form is not for emergencies. If the patient needs urgent medical help, call 000.

Questions about a booking? Call 1300 303 419 or email nept@promedtas.com.au.