Community Health Nursing Referral

This form should be completed by the medical professional making the referral, or an administrative assistant completing it on their behalf. This includes general practitioners, primary care physicians, surgeons, nurses, and allied health professionals.

The referral form is shared across several Community Health Referral services. When you start the form, select Community Health Nursing Referral from the Choose a Community Health Referral list.

Have the following information ready:

1. Your details: name, role, and contact information
2. The referral date
3. The patient's details: name, gender, date of birth, contact information, home address (or confirmation of no fixed abode), and insurance provider
4. Parent, guardian, or next-of-kin details, including any additional emergency contacts (if applicable)
5. The patient's primary care physician or GP, and their practice, ward, or facility
6. The patient's mobility status: homebound, limited mobility, or ambulatory
7. Whether the patient is aware that this referral is being made

Once submitted, your referral is sent to the Community Health Nursing team at the Department of Health for review. They will follow up to arrange care based on the patient's needs and mobility status.