Pathway Proposal Form

Please complete the form below if you would like to propose the development of a new pathway.

For SLHD Services the proposed pathway needs to reflect the whole of service, particularly those that are multi-centred.

First name

Last Name

Position/Role

Place of Practice

Name of proposed Pathway(s)

The Proposed pathway is a priority for primary/community clinicians or the Central & Eastern Sydney PHN

YesNoNA

The Proposed pathway is a priority for secondary/specialist clinicians or SLHD

YesNoNA

Reasons for priority status

How would the proposed pathway benefit the local population

Estimated frequency of pathway use by primary/community clinicians

(SLHD proposals only) Service redesign needed to make the pathway achievable

YesNo

If your response was Yes please detail extent of redesign required

Additional comments

Security Code

Enter the code shown above in the box below.

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