MAKE A REFERRAL

Our team will review the referral and determine whether RASAK CARE can appropriately meet the person’s support requirements.

Refer Someone to RASAK CARE

We welcome appropriate referrals from:

We welcome enquiries from:

Support Coordinators
Plan Managers
Health Professionals
Allied Health Professionals
Social Workers
Hospitals & Discharge Teams
Community Organisations
Government Agencies
Schools & Educational Professionals
Family Members
Carers
Guardians
Nominees
Other authorised representatives

REFERRAL FORM

First Name

Last Name

Organisation

Position / Relationship to Participant

Phone Number

Email Address

Referrer Type

Person Being Referred

First Name

Last Name

Preferred Name

Date of Birth

Phone Number

Email Address

Address

Suburb

Postcode

Preferred Language

Interpreter Required?

Preferred Communication Method

REFERRAL SERVICE REQUIREMENTS

What Type of Support Is Required?
Select one or more:

NDIS & Disability Support

Aged Care

Children & Family Services

Community Care

Other

FUNDING INFORMATION

Funding / Program

If NDIS

NDIS Number

Plan Start Date:

Plan End Date:

Plan Management:

Plan Manager Details

If applicable:

Support Coordinator Details:

If different from referrer:

SUPPORT INFORMATION

Tell Us About the Person's Support Needs

Primary support requirements

Goals

Preferred days/times for support

Approximate hours of support required

Important Support Information

Where relevant, please advise whether there are known requirements relating to:

Please provide relevant details:

RISK & SAFETY INFORMATION

Help Us Understand Any Important Safety Requirements

Are there any known risks or safety considerations relevant to providing the requested support?

If Yes:

Please provide details.

This information helps RASAK CARE determine whether appropriate assessment, staffing, training or other safeguards are required before services can commence.

DOCUMENT UPLOAD

Supporting Documents

Where available and appropriate, referrers may upload relevant documents such as:
NDIS Plan
Support Plan
Behaviour Support Plan
Health Management Plan
Risk Assessment
Allied Health Reports
Hospital Discharge Information
Other Relevant Documents

REFERRAL CONSENT

Before submitting the referral:

I confirm that I am authorised to provide the information contained in this referral and, where required, have obtained appropriate consent from the person being referred or their authorised representative for this information to be provided to RASAK CARE.

I understand that submitting a referral does not guarantee that RASAK CARE will be able to accept or commence the requested service.

I acknowledge that personal information provided through this form will be handled in accordance with RASAK CARE's Privacy Policy and applicable privacy obligations.

WHAT HAPPENS AFTER A REFERRAL?

What Happens Next?

We Receive the Referral

Our team reviews the information submitted.

We Contact You

Where additional information is required, we contact the participant, representative or referrer.

We Review Support Requirements

We consider the person’s needs, location, funding, service requirements, risks and our current service capacity.

We Confirm Whether We Can Assist

If RASAK CARE can appropriately provide the requested support, we discuss the proposed service arrangement and next steps.

Service Documentation

Required assessments, consent, service agreements and other documentation are completed.

Support Commences

Services commence once the necessary arrangements are in place.