Palliative care referral form
PDF 580 KB
Referrals to specialist palliative care services in South Australia must meet certain criteria and require completion of this palliative care referral.
Care for people with a life-limiting illness is often provided by a general practitioner and other primary health care providers. All professionals caring for people with a life-limiting illness need to assess and identify palliative and supportive care issues in initial treatment planning and throughout the progress of the disease.
Specialist palliative care teams work in a consultative role with general practitioners and other health care providers when these needs cannot be met by primary care teams, across a range of health care services, from hospitals, hospice care, or in the community such as home or residential care.
A person is eligible for referral to specialist palliative care services if:
If a person does not meet these three eligibility criteria outlined above, the referrer should contact the palliative care service to discuss the referral with a member of the specialist palliative care team.
Referrals can be made by medical practitioners, other health professionals and the individual or family members/carer.
Referrals for people in the community (that is, home or residential care), or people requiring an outpatient clinic appointment, can be made by faxing a completed Palliative Care Referral form (PDF 584KB) to your local palliative care service.
This form is available as a writable PDF - Palliative Care Referral form (PDF 584KB).
New referrals will be processed during office hours Monday to Friday 9.00 am to 4.00 pm.
Patients in an acute setting/hospital are referred using local inpatient procedures.