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Serving the community within the Serpentine, Jarrahdale region of Western Australia

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Home
About
- About Us
- How It Works
Services
Make a Referral
Blog
Contact

General Practitioner Referral

Thank you for referring a patient or client to Rensat Nursing Services. Please provide the clinical, discharge and support information needed for safe and timely follow-up.

1. Referrer Details

Full name(Required)

Hospital / health service(Required)

Department / ward

Position / profession

Phone number(Required)

Email address

2. Client Details

Patient / client's full name(Required)

Date of birth

Suburb / location

Phone number

Email address

3. Guardian or Authorised Representative

Does the client have a guardian or authorised representative?(Required)

No

Yes - please complete the details below

Full name

Relationship to client

Phone number

Email address

4. Admission and Discharge Information

Current ward / unit

Admission date

Expected discharge date

Discharge destination

5. Clinical Summary and Reason for Referral

Primary diagnosis / health conditions(Required)

Reason for referral(Required)

6. Services Required

What services or supports are required following discharge or transfer?(Required)

7. Urgency of Care

How urgently does the client require care or contact?(Required)

Immediate / critical - contact as soon as possible

Urgent - within 24 hours

High priority - within 2 business days

Routine - within 1 week

No immediate urgency / planned support

Clinical reason for urgency / required start date

8. Known Risks, Alerts and Care Requirements

Known risks / clinical alerts

Include relevant medical alerts, infection risks, behaviours, mobility or falls risks, swallowing needs, equipment, medication, communication or discharge concerns. If there is an immediate risk to life or safety, call 000 - this referral form is not an emergency service.

9. Consent and Supporting Information

Consent(Required)

I confirm that the patient or their authorised representative has consented to this referral and to Rensat Nursing Services making contact.

Please indicate any information supplied with this referral

Discharge summary attached

Medication list attached

Care plan / clinical handover attached

Other supporting information attached

10. Who Should We Contact?

Who should Rensat Nursing Services contact first regarding this referral?(Required)

Patient / client

Hospital / healthcare referrer

Guardian / authorised representative

Other - please specify

Please specify

Preferred contact method / time

Referral ID

Person-centred
Clinically Led
Integrity Inspired
Delivered with Dignity

Providing nursing services to locals in Serpentine–Jarrahdale Shire, Byford and surrounding areas.

"The Rensat nurse provided exceptional, caring support for my mother in her final months."

John North Byford, WA

"Thank you for caring so well for me during my rehab. Your support was life-changing every day."

Jess Simms Jarrahdale, WA

"Thank you to you and your team for caring for me during my lengthly recovery. Both nurses provided excellent nursing services."

Geoff S Serpentine, WA

We provide tailored nursing solutions, supporting clients throughout the Serpentine, Jarrahdale Shire and surrounding areas. Whatever your situation, please contact us. We listen with care, respond with action and are here to support you.

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Contact Details

Serving the community within the Serpentine, Jarrahdale region of Western Australia

0457 360 173

Make a Referral

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