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 Treating Doctor.Name
Practice.Name
Practice.Address
Phone: Practice.Phone
Fax: Practice.Fax
Email: Treating Doctor.E-mail
Provider Number: Treating Doctor.Provider Number

Miscellaneous.Date

Dear Provider

SECTION 1 Patient details

RE: Patient Demographics.Full Name
DOB: Patient Demographics.DOB
AGE: Patient Demographics.Age

Gender: Patient Demographics.Gender
Address: Patient Demographics.Address
Home Ph: Patient Demographics.Phone (Home)
Mobile Ph: Patient Demographics.Phone (Mobile)
Medicare Number*: Patient Demographics.Medicare Number  (*Medicare ineligible patients will incur a consultation fee)
Aged Care Number: Aged Care Number	Next of Kin/Alternative Contact: Patient Demographics.NOK Name
Next of Kin/Alternative Contact Ph: Patient Demographics.NOK Mobile Phone
Does the patient identify as Aboriginal and/or Torres Strait Islander: Does the pt identify
Interpreter required: Interpreter required
If yes, specify language: If yes, specify lang
Disability: Disability
If yes, what is the nature of the disability: If yes, disability
Marital status: Patient Demographics.Marital Status
Does the patient live alone: Live alone
If other, please specify: Specify live alone	

SECTION 2 Referral details

What is the main reason/s for this referral? Reason for referral

Is the patient eligible for Government funded Aged Care Services: Aged Care Services

Is the patient receiving services from an approved Aged Care Package: 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 and over

OR

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

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+ and A&TSI

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): Daily living tasks

OR

The patient is frail or prematurely aged and experiencing housing stress/not having secure accommodation: Frail/prem aged

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

Isolation or no available support person: Isolation

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

Difficulty processing information to make decisions: Decisions

Past experiences that mean they are hesitant to engage with aged care, institutions or government for any reason: Hesitant

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 risk

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:
Clinical

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

If any existing supports or services are in place, please provide relevant details:
Supports

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

Alcohol: Clinical Details.Alcohol
Smoking: Clinical Details.Smoking

Clinical Details.Problem List (Current) With Comments

Clinical Details.Problem List (Resolved) With Comments

Allergies: Clinical Details.Allergies

Current prescribed medications: Clinical Details.Medications - Current Regular

History of falls: Falls history