Health Professional Referrals

Thank you for referring your client to Cittamani Hospice.

Before completing the online referral form, please call our team to discuss the suitability of referral to our service. Please call 5445 0822.

Criteria for referral:

• Client has a life limiting illness and a expected prognosis of 3 – 6 months
• Client requires symptom management
• Client lives within Cittamani Hospice’s catchment area (https://www.cittamanihospice.com.au/area-we-cover/ )
• Client has a full-time live-in carer
• Client and/or their decision maker is aware of, and agrees to, palliative care referral
• Client or their decision maker agrees to the primary goals of Cittamani Hospice – to control symptoms, offer psychosocial support, maintain quality of life, and respect the client’s/family’s end of life wishes

To avoid delay in processing your referral, please ensure to include current medical information – either by uploading the documents via the referral form, or faxing/emailing it to us separately.

Current documentation should include:

• Current medication list
• Specialist or doctor’s letters/reports/discharge summary
• Recent medical imaging and pathology results
• Any Advanced Health Directives or Enduring Power of Attorney forms/ARP

If the referral meets our criteria, our Clinical Nurse Coordinator will contact the client directly to triage their needs and arrange an admission visit in the home. They may also contact you to discuss the referral in more detail if required.