Practice Profile

The information you provide for this profile will be used to facilitate a smooth transition of the locum doctor to your town for the benefit of the practice and the locum. The information will also be used as a resource for future locum placements and should be regularly updated.

Please note that fields marked with an asterisk (*) are required in order to successfully register your application.

Practice Particulars

1) Who will the locum replace?
*Surname
*First Name
*Preferred Name
Other Names
2) What are the practice contact details?
*Practice Telephone (Business hours)
*Practice Telephone (After hours)
*Fax
*Email
3) Medical Software
Medical Software used in the Practice
4) When is the locum required? Locums usually arrive Sunday evening to begin work on Monday morning and end a placement on Friday afternoon. This is to allow travelling time between placements.
*From:	Date: Time:
*Until:	Date: Time:
5) Where will the locum be expected to practice?
*Principal Practice Location
Other Practice Locations (local hospital, Nursing Home, Satellite Practices)

Proposed Roster for the Locum

6) Practice Obligations Practice staff are requested to provide a detailed daily roster.
*Usual hours for consultations? e.g. 08:30-11:30, 14:00-17:30
*Average Patient load per day?
*Expected availability for telephone calls?
*On-call practice required (home visits and after hours practice work)
7) Other Obligations
*On-call hospital frequency e.g. 1:3
*Dates and times of hospital on-call obbligation
*Are additional routine clinical obligations present? e.g. nursing home rounds
*Normal Start and Finish times of the working day including all hospital obligations as appropriate

Proposed accommodation (please see RDN's Locum Accommodation Policy)

*8) Please select the appropriate option	If Other:
*9) Address
*Address Line 1
Address Line 2
*Place Name
*State
*Postcode
*Contact Number

Accommodation Checklist

10) Please Ensure the following are provided
Adequately furnished	Yes: No:
Cooking facilities provided	Yes: No:
Linen supplied and bed(s) made up	Yes: No:
List of emergency and domestic contact numbers rovided e.g. electrician, plumber, vet	Yes: No:
Written instructions for use of household items e.g. Air Con, Security system, garbage disposal, garbage pick-up times	Yes: No:
Name and after hours contact number of two people with knowledge of the house and/or practice	Yes: No:
Your mail has been held at the Post office until your return	Yes: No:

Additional Domestic Requests(if accommodation is the GP's private residence)

11) Domestic
Animal Care requested? (please give details)
Garden or plant maintenance requested? (please give details)

Clinical Handover

12) Who is the GP responsible for clinical handover of practice and hospital patients?
*Surname
*First Name
Other names
*Preferred name
*What is the planned time and date of handover?	Date: Time:
*Where will the handover meeting be held?
13) Please ensure the following instructions are provided:
How to organise pathology/ X-ray	Yes: No:
Contact list for referrals to specialists	Yes: No:
Contact GP for clinical difficulties	Yes: No:
Contact list for local medical services	Yes: No:
Use of equipment e.g. pager, login for PC etc	Yes: No:
Routine billing procedure	Yes: No:

Meet and greet

Please meet (or arrange for someone else to meet) the locum upon arrival to your town; and then introduce the locum to their accommodations, the general local area, shopping facilities, and if possible, provide a meal for the locum on the first night (this is typically a Sunday night when shopping / eating out might be difficult).

14) Who will meet and greet the locum doctor?
*Surname
*First Name
Other Names
*Preferred Name
*Address Line 1
Address Line 2
*Place Name
*State
*Postcode
*Contact Number

If problems with the Locum placement arise, please contact your appropriate Locum Service Regional Coordinator. The locum will later be asked to evaluate the placement to allow for review and improvement of the conditions of the placement.

Thank You. Please submit this form or print and return to

RDN Locums Service
Northern Region Coordinator
Barwon Division of General Practice
Fax: 02 6742 3699
locumnorth@nswrdn.com.au

RDN Locum Service
Southern Region Coordinator
Murrumbidgee Division of General Practice
Fax: 02 6953 6653
locumsouth@nswrdn.com.au

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