Hospital referral form
Helping patients transition safely from hospital to home.
For an urgent same-day referral, please call 1300 367 968 rather than using this form.
AGCR-56 Referral form
This form collects health information about the client. Please read how we handle it before you submit, and give a copy to the client or their representative when you obtain their consent.
How Ashand Care handles this information
Who is collecting it
Ashand Care and Services Pty Ltd (ABN 90 674 454 856), 1300 367 968, admin@ashandcare.com.au. Our privacy policy is at ashandcare.com.au/privacy-policy, and it explains all of this in more detail.
What we collect, and from whom
The client's name, date of birth, contact details, next of kin, reason for referral or diagnosis, clinical risks and expected discharge date, together with your own details as the referrer. We are collecting this from you rather than from the client. Health information is sensitive information under the Privacy Act 1988 (Cth) and carries stronger protections than ordinary personal information.
Why we collect it
To assess whether we can safely meet the client's needs, to plan and deliver their services, to contact them and their next of kin, to meet our funding and reporting obligations under Support at Home and the NDIS, and to keep the clinical records we are required by law to keep. We do not sell personal information and we do not use it for marketing.
If it is not provided
We may be unable to assess the referral or begin services.
Who we disclose it to
- our intake and care staff;
- the client and their authorised representative;
- the client's nominated providers and support coordinator, where relevant to their care;
- funding bodies, where we are required to report;
- our IT service providers, who host this form and our records under contract.
Where it is held
In Australia. This form, and the records it creates, are held on Microsoft cloud services in Australian data centres. We are not likely to disclose the information to recipients outside Australia. If that changes we will update this notice.
Telling the client
Because we are collecting the client's health information from you rather than from them, we are required to take reasonable steps to make them aware of this notice. Please pass it on when you obtain their consent. We will also provide it at intake.
Access, correction and complaints
The client may ask us for access to their information, or ask us to correct it, by contacting our Privacy Officer on 1300 367 968 or at admin@ashandcare.com.au. If they are not satisfied with our response, they can complain to the Office of the Australian Information Commissioner (oaic.gov.au, 1300 363 992) from anywhere in Australia. Clients in some states have an additional avenue: in New South Wales, the Information and Privacy Commission NSW or the Health Care Complaints Commission; in Victoria, the Health Complaints Commissioner; in the Australian Capital Territory, the ACT Human Rights Commission.
How long we keep it
For as long as we need it to provide the client's services, and after that for as long as the law requires. How long that is depends on the kind of record; our privacy policy explains this.
Not enough time to fill this in?
This form asks for a lot, because the more we know up front the sooner services can start safely. If you cannot work through it now, call 1300 367 968 or and we will take the referral with you and sort out the details between us. You do not need everything in front of you to start.