MANDATORY REFERRAL TEMPLATES

Mandatory Referral Templates

COMBINED SCTT AND PALLIATIVE CARE REFERRAL FORMS

If you are making a palliative care referral into the North and West Metropolitan Region you need to include the following SCTT 2006 forms:
• Confidential Referral Cover Sheet (1 page),
• Consumer Information (1 page),
• Summary and Referral Information (2 pages).

To assist the preparation of referrals from these agencies, a number of combined referral forms have been developed. These forms are Microsoft Word documents that combine one or more SCTT forms, and the PCCR, into a single form set which you can get by clicking here. The SCTT 2006 forms supplied in these combined referral forms have been modified slightly to simplify completion online or by hand, and to meet the specific requirements of palliative care referrals.

In addition, a supplementary form (specific for palliative care) is required:
• Palliative Care Clinical Referral form (PCCR, 3 pages).