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Patient Info
NHI
Date of birth
GP Referral date
Package of Care Ends
Session Info
Session number
Package of care ID
Appointment date
Claim number
South Taranaki Travel Distance
In person
True
False
Did not attend
True
False
Rural Travel Time
True
False
Group session
True
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Estimates (not the final costs)
Session Rate
South Taranaki Travel Cost
Total Cost
Total + GST (registered)
Group Session
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Anxiety Management
Grief and Loss
Bereavement Loss
Emotional Regulation
Group ID
Assessment
Presenting issue
Antenatal/Postnatal wellbeing
Anxiety
Alcohol and other Drug issues
Addiction other (not AOD)
Attention deficit hyperactivity disorder
Depression / Low mood
Eating issues
Generalised stress
Grief & Loss
Self-harm
Severe enduring mental illness
Sexual & Gender Identity
Suicidal ideation
Trauma (incl. PTSD)
Pain
Physical health concerns
Sleep
Family related stress
Family Harm
Financial stress
Housing
Parenting issues
Relationship issues
School-related bullying/harassment
Sexual Harm
Recent Unemployment
Workplace bullying/harassment
Assessment tool 1
Please select...
Kessler
PHQ9
GAD 7
Hua Oranga
EPDS
DASS 21 (Depression)
DASS 21 (Anxiety)
DASS 21 (Stress)
RCADS – Separation Anxiety
RCADS – Social Phobia
RCADS – GAD
RCADS – Panic Disorder
RCADS – OCD
RCADS – Major Depression
Did not complete (not preferred)
Assessment score 1
Assessment tool 2
Please select...
Kessler
PHQ9
GAD 7
Hua Oranga
EPDS
DASS 21 (Depression)
DASS 21 (Anxiety)
DASS 21 (Stress)
RCADS – Separation Anxiety
RCADS – Social Phobia
RCADS – GAD
RCADS – Panic Disorder
RCADS – OCD
RCADS – Major Depression
Assessment score 2
Assessment tool 3
Please select...
Kessler
PHQ9
GAD 7
Hua Oranga
EPDS
DASS 21 (Depression)
DASS 21 (Anxiety)
DASS 21 (Stress)
RCADS – Separation Anxiety
RCADS – Social Phobia
RCADS – GAD
RCADS – Panic Disorder
RCADS – OCD
RCADS – Major Depression
Assessment score 3
Assessment tool 4
Please select...
Kessler
PHQ9
GAD 7
Hua Oranga
EPDS
DASS 21 (Depression)
DASS 21 (Anxiety)
DASS 21 (Stress)
RCADS – Separation Anxiety
RCADS – Social Phobia
RCADS – GAD
RCADS – Panic Disorder
RCADS – OCD
RCADS – Major Depression
Assessment score 4
Assessment tool 5
Please select...
Kessler
PHQ9
GAD 7
Hua Oranga
EPDS
DASS 21 (Depression)
DASS 21 (Anxiety)
DASS 21 (Stress)
RCADS – Separation Anxiety
RCADS – Social Phobia
RCADS – GAD
RCADS – Panic Disorder
RCADS – OCD
RCADS – Major Depression
Assessment score 5
Assessment tool 6
Please select...
Kessler
PHQ9
GAD 7
Hua Oranga
EPDS
DASS 21 (Depression)
DASS 21 (Anxiety)
DASS 21 (Stress)
RCADS – Separation Anxiety
RCADS – Social Phobia
RCADS – GAD
RCADS – Panic Disorder
RCADS – OCD
RCADS – Major Depression
Assessment score 6
Outcome (to be completed on last session or extension)
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Patient Info
NHI
Date of birth
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Package of Care Ends
Session Info
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1
2
3
4
5
6
7
8
9
10
11
Appointment date
Claim number
South Taranaki Travel Distance
In person
True
False
Did not attend
True
False
Rural Travel Time
True
False
Group session
True
False
Estimates (not the final costs)
Session Rate
South Taranaki Travel Cost
Total Cost
Total + GST (registered)
Group Session
Group type
Please select...
Anxiety Management
Grief and Loss
Bereavement Loss
Emotional Regulation
Group ID
Assessment
Presenting issue
Antenatal/Postnatal wellbeing
Anxiety
Alcohol and other Drug issues
Addiction other (not AOD)
Attention deficit hyperactivity disorder
Depression / Low mood
Eating issues
Generalised stress
Grief & Loss
Self-harm
Severe enduring mental illness
Sexual & Gender Identity
Suicidal ideation
Trauma (incl. PTSD)
Pain
Physical health concerns
Sleep
Family related stress
Family Harm
Financial stress
Housing
Parenting issues
Relationship issues
School-related bullying/harassment
Sexual Harm
Recent Unemployment
Workplace bullying/harassment
Assessment tool 1
Please select...
Kessler
PHQ9
GAD 7
Hua Oranga
EPDS
DASS 21 (Depression)
DASS 21 (Anxiety)
DASS 21 (Stress)
RCADS – Separation Anxiety
RCADS – Social Phobia
RCADS – GAD
RCADS – Panic Disorder
RCADS – OCD
RCADS – Major Depression
Did not complete (not preferred)
Assessment score 1
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Outcome (to be completed on last session or extension)
POC Outcome
Discharge Outcome
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Waikato
Taranaki
Tairawhiti
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Te Kauwhata
Te Kuiti
Thames
Tirau
Tokoroa
Waihi
Whangamata
Interventions
Acceptance Commitment therapy – (ACT)
Mindfulness
Cognitive Behaviour Therapy –(CBT)
Trauma informed Psychotherapy
Dialectical Behaviour Therapy –(DBT)
Solutions focused Therapy.
Eye Movement Desensitisation Reprocessing – (EDMR)
Grief/Loss
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Sensory Modulation
Motivational Interviewing – (MI)
Self Esteem
Relapse Intervention
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Te Whare Tapa Wha
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Taranaki
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