CARE FINDER PROGAM

PROVIDERS: 

Footprints Community
Multicultural Communities Council Gold Coast
Star Community Services (Not on Medical Objects)

Send via Medical Objects or Healthlink to:

Footprints Community
COMMUNITY FOOTPRINTS CF4006000HQ
OR
Multicultural Communties Council Gold Coast
COMMUNITY SERVICES CURA CC4214000VP	FROM <DrName>
<Practice>
<UsrAddress>
Phone: <UsrPhone>
Fax: <UsrFax>
Email: <PracEmail>
Provider Number: <DrProviderNo>

<TodaysDate>

Dear Provider

SECTION 1 Patient details

RE: <PtFullName>
DOB: <PtDoB>
AGE: <PtAge>

Gender: <PtSex>
Address: <PtAddress>
Home Ph: <PtPhoneH>
Mobile Ph: <PtPhoneMob>
Medicare Number*: <PtMCNo> (*Medicare ineligible patients will incur a consultation fee)
Aged Care Number: <Aged Care Number>	Next of Kin/Alternative Contact: <NOKName>
Next of Kin/Alternative Contact Ph: <NOKContact>
Does patient identify as Aboriginal and/or Torres Strait Islander: <Does pt identify as Aboriginal/Torres Strait Islander>
Interpreter required: <Interpreter required>
If yes, specify language: <If yes, specify language>
Marital status: <PtMaritalSt>
Disability: <Does the patient have a disability?>
If yes, what is the nature of the disability: <If yes, what is the nature of the disability>
Does the patient live alone: <Does the patient live alone>
If other, please specify: <If other, please specify>	

SECTION 2 Referral details

What is the main reason/s for this referral? <What is the main reason/s for this referral?>
Is the patient eligible for Government funded Aged Care Services? <Patient eligible for Government Funded Aged Care Services>

Is the patient receiving services from an approved Aged Care Package? <Patient receiving services from approved Aged Care Package>

SECTION 3 Eligibility criteria for Care Finder referral patients (please answer all sections)

To be eligible for the Care Finder program the patient must meet one of these 3 options:

Is the patient 65 years and over: <Is patient 65 years and over>

OR

Is the patient 50 years or older and on a low income and homeless or at risk of being homeless: <Is patient 50+ and low income and homeless or at risk of>

OR

Is the patient 45 years or older, Aboriginal or Torres Strait Islander and on a low income and homeless or at risk of being homeless: <Is patient 45+, A&TSI, low income and homeless or at risk of>

To be eligible for the Care Finder Program the patient must also meet one of these 2 options:

The patient requires help (either with an aid or assistance from another person) to undertake one or more tasks of daily living (e.g. walking, dressing, preparing meals, making decisions, eating, managing medication, managing with housework, transportation, social connects): <Does patient require help with daily living tasks>

OR

The patient is frail or prematurely aged and experiencing housing stress/not having secure accommodation: <Is patient frail/prematurely aged and experiencing housing stress>

SECTION 4 Care Finder target population should meet the following criteria

The patient is without family, friends, carer or representative they would be comfortable to receive help from and who is willing and able to help them access aged care services:  <Patient has no friends/family to help access services>

To be eligible at least one of the following situations must be met:

Isolation or no available support person: <Patient is isolated with no available support person>

Communication barriers, including limited English and health literacy skills: <Patient has communication/language barriers and limited health literacy>

Difficulty processing information to make decisions: <Patient has difficulty processing information to make decisions>

Past experiences that mean they are hesitant to engage with aged care, institutions or Government for any reason: <Patient is hesitant to engage with aged care, institutions, etc> 

Their safety is at immediate risk, or they may end up in a crisis situation, but are also resistant to engaging with aged care: <Patient's safety is at risk or potential crisis situation and resistant to engage>

NB: If a patient is at immediate risk, connect them with appropriate emergency services.

Please provide any relevant clinical and social information that can assist our staff in supporting your patient in the most appropriate manner:
<Provide relevant clinical and social information>

Please outline in detail any barriers to accessing My Aged Care and aged care supports as well as any specific challenges facing the patient:
<Outline barriers to My Aged Care/supports and challenges>

If any existing supports or services are in place, please provide relevant details:
<List existing supports/services in place>

SECTION 5 Medical history including co-morbidities and previous surgical interventions

Alcohol: <AlcHx>
Smoking: <SmkStatus> <SmkHx>
<PMHAll>
Allergies: <Reactions>
Current prescribed medications: <CurrentRx>
History of Falls: <Does the patient have a history of falls? Provide information as relevant>