Service Coordination Referral Form

For a person aged 65 years or over, please complete the referral for the Commonwealth Home Support Program online through My Aged Care or telephone the My Aged Care Contact Centre on 1800 200 422.

For a person aged under 65 years for the Home and Community Care Program for Younger People, District Nurses and Occupational Therapists etc please complete the following pages from the SCTT2012 referral with as much information as possible and fax to our Intake Officer on 03 5272 4752:

  • Accommodation and safety arrangements

  • Care relationship, family and social network

  • Consent to share information

  • Consumer information

  • General Practice Referral - this form can be completed by a GP or Practice Nurse instead of the SCTT2012 forms and sent by  fax to our Intake Officer on 03 5272 4752

  • Need of assistance with activities of daily living

  • Summary and referral information





Page last updated: Wednesday, 3 October 2018

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