Referrer Eating Disorders Management Plan (EDMP)

If you are looking to create an EDMP for a patient whom you intend on referring to CFIH, please complete our "Referral form & GP Management Form" which includes a CFIH referral form, medical clearance form, and GP management form all in one. 

If you are looking for CFIH's medical clearance or medical monitoring forms, you can find the adult form here and the under 18's form here

Referrer Details

Please provide the email address you'd like a completed copy of this form sent to.

Patient Details

Eligibility for EDMP

For BN, BED, and OSFED diagnoses, the following additional criteria must be met (below) 

Score ≥ 3 for eligibility
At least 1 for EDMP eligibility
At least 2 for EDMP eligibility

Initial Treatment Recommendations Under EDMP

Assessment by psychiatrist/pediatrician is required for the patient to access EDMP psychological sessions 21-40
For example: Restore/stabilise weight, reverse malnutrition, reduce compensatory behaviours, address body image disturbance

Physical Assessment


Moderate Alert - Monitor Weekly

High Alert - Meets Admission Criteria

BMI < 16

BMI < 13

Weight loss >0.5kg for several weeks

Weight loss 1kg or more for several weeks

Systolic - 90mmHg

Diastolic - 60mmHg

Systolic - 80mmHg

Diastolic - 50mmHg

OR postural drop >10mmHg



OR postural tachycardia >20bpm increase

<36° C

<35.5° C

OR cold/blue extremities

Phosphate: 0.5-0.9mmol/L

Potassium: <3.5mmol/L

Sodium: <130mmol/L

Phosphate: <0.7mmol/L

Potassium: <3.0mmol/L

Sodium: <125mmol/L

AST >40

ALT >45

AST >100

ALT >100

Albumin <35g/L

Glucose <3.5mmol/L

Albumin <30g/L



OR prolonged QT interval >450msec 

OR arrythmias



OR rapidly dropping (25% within a week)

Neutrophils <1.2 x 109/L

Neutrophils <1.5 x 109/L

Swollen ankles

Pitting oedema 

Significant bruising


Referral Requirements

Please bill MBS item #90250-90253 (more information on billing codes can be found here)


agree to information about my mental and medical health to be shared between the GP and the health professionals to whom I am referred, to assist in the management of my health care. 

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have discussed the proposed referral(s) with the patient and am satisfied that the patient understands the proposed uses and disclosures and has provided their informed consent to these.

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