Online Referrals

THE FOLLOWING INFORMATION IS FOR HEALTH PRACTITIONERS ONLY

If you are NOT a Health Practitioner, you may proceed to submit your online referral HERE.

Primary goals for EPC services are to control symptoms, offer psychosocial support and maintain quality of life. We are not funded to provide personal care.

Anyone requiring palliative care may be referred to our service provided they reside in the Local Government areas of Boroondara, Manningham, Maroondah, Monash, Whitehorse, Knox or Yarra Ranges and meet the below criteria:

• Client has a progressive, life limiting illness with a prognosis of around 12 months or less
• Client has complex symptom management issues that cannot be addressed by current caring team
• Client or their decision maker is aware of and agrees to palliative care referral

IN ADDITION TO COMPLETING THE ONLINE REFERRAL FORM:

To avoid delay in processing your Referral, please ensure copies of all relevant medical information is provided: e.g. Current Medication List, Admission Sheet / Registration Sheet, Scans, Blood, Relevant specialist letters and doctor’s notes.

THIS INFORMATION SHOULD BE UPLOADED VIA THE REFERRAL FORM (Documentation Tab) OR FAXED TO: (03) 9873 0919

IF THE REFERRAL IS URGENT, PLEASE PHONE OUR INTAKE NURSE: 1300 130 813

Please proceed to online referral by selecting the Referral Form Button below.