CARE FINDER PROGRAM

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 Communities Council Gold Coast
COMMUNITY SERVICES CURA CC4214000VP	FROM <<Doctor:Name>>
<<Practice:Name>>
<<Practice:Address>>
Phone: <<Practice:Phone>>
Fax: <<Practice:Fax>>
Email: <<Doctor:E-mail>>
Provider Number: <<Doctor:Provider Number>>

<<Miscellaneous:Date (long)>>

Dear Provider

SECTION 1 Patient details

RE: <<Patient Demographics:Full Name>>
DOB: <<Patient Demographics:DOB>>
AGE: <<Patient Demographics:Age>>

Gender: <<Patient Demographics:Sex>>
Address: <<Patient Demographics:Full Address>>
Home Ph: <<Patient Demographics:Phone (Home)>>
Mobile Ph: <<Patient Demographics:Phone (Mobile)>>
Medicare Number:<<Patient Demographics:Medicare Number>> <<Patient Demographics:Medicare Expiry Date>>
Aged Care Number: <<Aged Care Number >>
Consent: <<Consent for referral has been obtained from patient>>
	Next of Kin/Alternative Contact: <<Patient Demographics:Next of Kin>>
What is the relationship of the next of kin to the patient: <<What is the relationship of the next of kin to patient>>
Next of Kin/Alternative Contact Ph: <<Patient Demographics:Next of Kin Phone>>
Does patient identify as Aboriginal and/or Torres Strait 
Islander: <<Patient Demographics:ATSI>>
Interpreter required: <<Interpreter required>>
If yes, specify language: <<If yes, specify language>>
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?>>
Marital status: <<Patient Demographics:Marital Status>>
Does patient live alone: <<Does 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 Gvt Funded Aged Care Services>>

Is the patient receiving services from an approved Aged Care Package?: <<Receiving services from 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: <<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: <<50+ and low income/homeless or 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: <<45+ A&TSI, low income and homeless or 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): <<Requires help daily living tasks>>

OR

The patient is frail or prematurely aged and experiencing housing stress/not having secure accommodation: <<Frail/prematurely aged+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: <<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: <<Isolation or no available support person>>

Communication barriers, including limited English and health literacy skills: <<Comms/language barriers/limited health literacy>>

Difficulty processing information to make decisions: <<Difficulty processing information to make decisions>>

Past experiences that mean they are hesitant to engage with aged care, institutions or government for any reason: <<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: <<Safety at risk/potential crisis situation & resistant>>

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

Please provide any relevant social information that can assist our staff in supporting your patient in the most appropriate manner.
<<Provide other relevant information (eg cultural) >>

Please outline in detail any barriers to accessing My Aged Care and aged care supports as well as any specific challenges facing the patient.
<<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: <<Clinical Details:Alcohol>>
Smoking: <<Clinical Details:Smoking>>
<<Clinical Details:History List>>

<<Operation:CoMorbidities>>

<<Operation:Previous Procedures>>

Allergies: <<Clinical Details:Allergies/Adverse Reactions>>

Current prescribed medications: <<Clinical Details:Medication List>>

History of falls: <<Provide information of any past falls>>