Online Referrals

If you are NOT a Health Practitioner, you may proceed to submit your online referral via the green referral button below.

THE FOLLOWING INFORMATION IS FOR HEALTH PRACTITIONERS ONLY

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 prognosis of around 12 months or less due to progressive, advanced, or incurable illness, frailty or old age;
• Client has, or is likely to develop, complex physical symptoms or psychosocial needs associated with their transition to end of life which are beyond the capacity of the primary care team to manage optimally;
• Client has confirmed Goals of Care that align with treatment for reversible causes only, or symptom support only and cardiopulmonary resuscitation is not an expectation.
• Client or their decision maker is aware of and agrees to a 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.

Re-referral

This form is to be used for people who have previously been referred to Eastern Palliative Care. If you have not previously had contact with the intake team about a referral for this person, please complete the referral form for new clients here.

Click here to make a re-referral