National Bowel Cancer Screening Program Forms

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• Purpose of National Bowel Cancer Screening Program Forms
• Electronic Forms
  • System requirements
  • Smart forms
  • Instructions for accessing and use of electronic forms
  • Links to electronic forms
• Manual (printer friendly) Forms
  • Links to manual forms
• Information Payment
• Program Privacy Notes
• How to order paper forms
• Text only Documents

Purpose of National Bowel Cancer Screening Program Forms

The purpose of the National Bowel Cancer Screening Program (NBCSP) Forms is to provide information to the NBCSP Register about participants in the Program.
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Electronic Forms

These forms can be downloaded, completed on your computer, saved and/or printed and submitted to the National Bowel Cancer Screening Register by selecting the "Submit" button on the form. These forms do not need to be sent by facsimile. If you wish to download a form to be sent to the National Bowel Cancer Screening Register by facsimile or by post, please use the manual versions of the forms. Links to download these forms appear under the heading Manual (Printer Friendly) Forms.

System Requirements

You will require Adobe Reader (at least version 8.1.1) to be able to submit the forms electronically to the National Bowel Cancer Screening Register. The latest version of Adobe Reader can be downloaded free of charge from Adobe website.

Smart Forms

Some sections of the electronic forms will only display after specific selections are made. For example, the Medicare Number format will display after the Medicare Number button is selected. Please do not print a blank copy of an electronic form to complete by hand because the information on the form will be incomplete. If you wish to download a form that you can complete by hand and send to the National Bowel Cancer Screening Register by fax or by post then go to the section headed Manual (printer friendly) Forms where there are links to the appropriate versions of the forms.

Instructions for Accessing and use of Electronic Forms

Select the form you wish to use, complete the form on your computer, and submit the form by selecting the submit button on the form. Forms submitted electronically will be sent to the National Bowel Cancer Screening Register by a secure email transmission. Confirmation will be provided where a form has been submitted successfully. The confirmation includes a reference number that can be used to track the delivery of the form if necessary. You may print and/or save a copy of this confirmation if you wish.

Links to electronic forms - Online Submission Only

Please note: To complete a form by hand, you must use the Manual (Printer Friendly) forms. Some sections of the electronic forms will not print.

GP Assessment Report
Instructions for GP Assessment Report (HTML) - Text only Document
Introducing the electronic GP Assessment Report (HTML) - Text only Document
To be completed by general practitioners to provide information about consultations with Program participants who have received a positive FOBT result.

Colonoscopy and Histopathology Report
Instructions for Colonoscopy and Histopathology Report (HTML) - Text only Document
Introducing the electronic Colonoscopy and Histopathology Report (HTML) - Text only Document
To be completed by colonoscopists to report the results of a colonoscopy and histopathologists to report the results from testing specimens collected during the colonoscopy procedure for a Program participant with a positive FOBT result. This form also enables colonoscopists to report adverse events which may have occurred during the procedure or are known at the time of completing this form. Information about this form is available to colonoscopists and histopathologists by selecting the available link

Procedure Report - Adverse Outcomes
Instructions for Procedure Report - Adverse Events (HTML) - Text only Document
Introducing the electronic Procedure Report - Adverse Events (HTML) - Text only Document
To be completed by colonoscopists to report information about an adverse outcome for a procedure relating to diagnostic investigation of a Program participant who has received a positive FOBT result. This form is only used where that information has not already been included in the Colonoscopy Report.

Histopathology Report
To be completed by a histopathologist to report the results for specimens collected during a surgical resection procedure from a Program participant with a positive FOBT result.
Please note: The use of this report for this purpose is a temporary arrangement pending the introduction of a Histopathology Resection Report.
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Manual (Printer Friendly) Forms

Links to download a copy of the paper based forms are set out below. These forms should be used if you wish to download the form. They can be completed on your computer or by hand and forwarded to the National Bowel Cancer Screening Program Register. These forms cannot be submitted electronically and must be sent to the Register by

1. facsimile to 1800 115 062; or
2. by post to The NBCS Program, Reply Paid 83061, Hobart, Tas, 7001

Links to manual forms

Payment Accounts Details for Service Provider Form (PDF)
A manual (printer friendly) version of the electronic form.
This form is used by a Service Provider (e.g., a sole trader or employer) to nominate a bank account in order to receive payments for notification of information provided to the National Bowel Cancer Screening Program Register via other forms. All information payments will be made to the bank account nominated on this form. One Payment Accounts Details for Service Provider Form should be completed for each provider using the provider number for the location.

GP Assessment Report (PDF 345 KB)
A manual (printer friendly) version of the electronic form.

Colonoscopy and Histopathology Report (PDF 514 KB)
A manual (printer friendly) version of the electronic form.

Procedure Report - Adverse Outcomes (PDF 338 KB)
A manual (printer friendly) version of the electronic form.

Histopathology Report (PDF 131 KB)
A manual (printer friendly) version of the electronic form.

Information Payment

The following information payments will be made for each correctly completed form that provides information to the National Bowel Cancer Screening Register about the progress of a Program participant through the screening pathway following a positive FOBT result:

• $14.30 (GST inclusive) for each Colonoscopy Report or Histopathology Report; and
• $7.70 (GST inclusive) for each GP Assessment Form or Adverse Outcomes Report.

Program Privacy Notes

Information from the Program Register is used to assist the delivery of the Program and monitor the Program’s performance. Information is used by:
1. The Department of Health and Ageing who is responsible for the overall operation of the Program;
2. The Department of Human Services who maintain the Program Register on behalf of the Department of Health and Ageing.
3. The Australian Institute of Health and Welfare who analyse data from the Program Register and provide published reports using de-identified data from the Program Register;
4. State and Territory Departments of Health and their contractors who assist the Department of Health and Ageing with the delivery of the Program in their jurisdictions; and
5. Health professionals who may be given information to assist with the medical care of their patient where their patient is a Program participant.

Australians in specified age groups are invited to participate in the Program and are provided with information about how their personal and clinical information will be used. The information is contained is a Privacy Note and Acknowledgement on the Participant Details Form which they sign if they agree to participate in the Program.

Information about the Program is contained in an Information Booklet which is given to persons being invited to participate. The booklet contains a section titled Protecting your personal information.

Health professionals who provide screening services to Program participants are provided with information on how the information they provide in respect of a participant on Program reporting forms they use to provide information to the Program Register. A copy of the privacy note can be viewed by selecting the link.

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Text only documents (HTML)

Text only versions of documents have been provided as an alternative format to assist with accessibility. If you have any problems accessing these forms please contact NBCSP at Department of Health and Ageing.

How to order paper forms

Contact the National Bowel Cancer Screening Information Line on 1800 118 868.

Page currency, Latest update: 04 March, 2009

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For further information email Cancerscreening
Australian Government Department of Health and Ageing