Our Referrals

Alexa Rose Home Care Service displays and provides information on different services and resources for individuals to participate in community organisations; this could include pamphlets, brochures or flyers. Information will be given in a veriety of amounts, where appropriate.

To provide current and potential participants with accurate and extensive information on services and possible providers for specific services. This ensures that participants have all relevant information before making any decisions.

Alexa Rose Home Care Service is required to create a database including all referrals; this is updated by delivery workers constantly. It is also beneficial for when participants have been denied service or wish to leave, as Alexa Rose Home Care Service can suggest services that may better suit the needs of the participant.

Workers must ensure that they are differentiating regarding information for their participants, to provide them with the correct information, relevant to their needs and services. They must also be sure to communicate in a way that is more suitable for the participant and easy to understand.

Referral Form

Referral Date:

Referral Managed By:

PARTICIPANT DETAILS

Surname

First Name* :

Is the NDIS Plan* :

GUARDIAN DETAILS (If applicable)

Surname

First Name* :

CONTACT DETAILS

Home Phone:

Mobile Phone* :

Position:

Email Address:

Address:

REFERRER DETAILS

Name* :

Position:

Organisation:

Contact Details* :

Referral Reason:

Email Id* :

FURTHER PARTICIPANT DETAILS

Country of Birth:

Preferred language:

Aboriginal or Torres Strait Islander?

Yes No Other Support Required (specify):

Interpreter Required?

Yes No

ACTION TAKEN / FOLLOW UP

PARTICIPANT/GUARDIAN DECLARATION

I consent to my information being provided to Arise Services for the purposes of referral, service delivery and inclusion in de-identified data reporting.

Full Name* :

Date

Signature of Participant/Guardian: