Day Therapy Unit

Referral information required

In order to process and intake patients as efficiently as possible, please provide all of the relevant information as follows.

Patient details

• Full patient name, date of birth, current residential and postal address (if different from residential), contact phone number/s.
• NOK details including contact phone number/s (NB; especially important for memory referrals).
• Information regarding language / dialect if interpreting services likely to be required.
• Medicare details, DVA and private health insurance information (where relevant).

Referrer details

• Full name and practice details including fax.
• Stamp with all details is sufficient.

Referral details

• Tick relevant box/es relating to reason for referral. Please note that more than one referral may be made on the one consultation form.
• Please enter text in the ‘details of referral’ box.
• Patients only requiring assessment for support services within the home and / or ACAT assessment, please refer via My Aged Care www.myagedcare.gov.au.

Risk assessment

• We request that this section is filled out for ALL referrals please where a home visit is requested to ensure the safety of our staff

  Mobility / Cognition / Continence / Mood

• It is important that these sections are completed, particularly the mobility / falls section where referrals are being made to Falls Clinic / Falls Physio Specialist / General Physiotherapy.
• Where patients are to be referred to Memory Clinic or to OT Memory Clinic, we request that the ‘Cognition / Behaviours’ section be completed in full.
• Include MMSE score and brief falls history – eg: number of falls in past 12 months.

Medical History / Medications

• A list of patient’s current conditions plus their relevant past medical history may be detailed under this section.
• Please also list CURRENT medications your patient is taking and any known allergies.
• It is also often helpful to have a current weight / BMI and details of any other medical specialists currently involved with the patient. Please forward relevant correspondence.
• Has the patient been seen elsewhere for the same problem or referred to another service for the same problem?
• We welcome the forwarding of any relevant imaging, diagnostic reports or results to accompany the referral – blood results, CT scan, BMD etc.

Sending referrals

• Referrals may be completed electronically and printed and subsequently faxed to Osborne Park Hospital on 6457 8232
• Alternatively, they may be printed as PDF, completed by hand and subsequently faxed to Osborne Park Hospital on 6457 8232