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REFERRAL FOR SPECIALIST PALLIATIVE CARE North Haven Hospice Shankara Phone: 09 437 3355 Fax: 09 437 6219 www.northhavenhospice.org.nz Email: admin northhavenhospice.org.NZ Hospice Kampala Danville
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How to fill out referral for specialist palliative
How to fill out a referral for specialist palliative?
01
Contact the patient's primary care physician or the healthcare provider in charge of their care.
02
Request a referral for specialist palliative care, ensuring that it is clearly stated in the referral.
03
Provide the patient's relevant medical information, including their diagnosis, current treatment plan, and any relevant test results.
04
Include the patient's contact information, as well as any information regarding their preferred method of communication or any specific needs they may have.
05
Specify the reason for the referral, highlighting the need for specialist palliative care services.
06
If applicable, outline any specific goals or outcomes you hope to achieve through the referral.
07
Ensure that the referral is signed and dated, indicating the requesting healthcare provider's name and contact information.
Who needs a referral for specialist palliative care?
01
Patients who are diagnosed with a life-limiting illness or a serious medical condition that requires specialized care to manage their symptoms and improve their quality of life.
02
Patients who are experiencing uncontrolled pain, physical discomfort, or emotional distress, which may benefit from the expertise of a specialist palliative care team.
03
Patients who require additional support and guidance in making informed medical decisions, setting personalized goals of care, and coordinating their medical treatment among different healthcare providers.
04
Patients whose primary care or current medical team believes that specialist palliative care could provide an added layer of comprehensive care and support for themselves and their families during a challenging time.
05
Patients and families who are in need of ongoing emotional, psychological, and spiritual support to cope with the complexities and emotional toll of their illness.
Please note that the need for a referral may vary depending on the healthcare system or the specific requirements of the palliative care program. It is always advisable to consult with the patient's primary care physician or healthcare team for guidance on the referral process and necessary steps.
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