A future where every journey is a safe one

Allied Health Treatment and Recovery Plan

The TAC will retain the information provided and may use or disclose it to make further enquiries to assist in the ongoing management of the claim or any claim for common law damages. The TAC may also be required by law to disclose this information.

Required fields are marked with an asterisk (*).
Allied Health Treatment and Management plan type *
Discipline *
Client details
Date of birth *
Date of accident *
Current work status *
Diagnosis and specific areas being treated
Outcomes You must supply the standard outcome measures used.
First Outcome measure used
Initial date
Subsequent date
Next subsequent date
Latest date
Add additional outcome measure
Second Outcome measure
Initial date
Subsequent date
Next subsequent date
Latest date
Add 3rd outcome measure
Third Outcome measure
Initial date
Subsequent date
Next subsequent date
Latest date
Screening Screening of psychosocial risk factors (barriers) to recovery
(Eg: Ӧrebro short form – see notes page)
Screening date
List any barriers that you have recognised and the steps you have taken or will be taking to address them
Goals of your treatment List current activity/functional limitations and related goals that your treatment will address.
Goal 1
Include ADL and work/travel goals
Estimated date of achievement *
Add 2nd goal
Goal 2
Include ADL and work/travel goals
Estimated date of achievement
Add 3rd goal
Goal 3
Include ADL and work/travel goals
Estimated date of achievement
Add 4th goal
Goal 4
Include ADL and work/travel goals
Estimated date of achievement

From *
to *

Anticipated discharge date
Your details

Acknowledgement

I have discussed this treatment plan with my patient and I agree to discuss this plan with members of the TAC clinical panel as required.  I understand that I can only bill the TAC for treatment that is directly related to my patient’s transport accident.

Your privacy

The TAC will retain the information provided and may use or disclose it to make further enquiries to assist in the ongoing management of the claim or any claim for common law damages. The TAC may also be required by law to disclose this information.
Without this information, the TAC may be unable to determine entitlements or assess whether the treatment is reasonable and may not be able to approve further benefits and treatment.
If you require further information about our privacy policy, please call the TAC on 1300 654 329 or visit our privacy policy.