SAH Referral

Make a referral

Thank you for choosing Smart Solutions Rehab Group to support you in reaching your goals. To make an SAH referral simply complete the online referral form below. Once we receive your referral, a Service Coordinator will contact you as soon as possible.

"*" indicates required fields

Name

This field is for validation purposes and should be left unchanged.

Referral Date

Referrer details

Referrer name*

First name Last name

Agency or organisation*

Phone*

Email*

Enter Email Confirm Email

Relationship to client*

Client/participant details

Client/participant name*

First name Last name

Date of birth*

Gender*

Client Address*

Suburb*

State*

Home phone

Mobile*

Email*

Preferred contact method

Client Information

Client Information Provided

Health Summary

Care Plan

Discharge Summary

MAC Assessment

Support Plan

Client Goals

Funding Details

SAH Ongoing Care Pathway (Level 1-8)

SAH – Short Term – Restorative Care Program Pathway

SAH – AT (Assistive Technology)

SAH – HM (Home Modifications)

SAH – End of Life Pathway

Self-Managed

HCP Transitioned

Support at Home Level (1-8)

Self-Managed

HCP Transitioned

Level 1

Level 2

Level 3

Level 4

SAH – AT funding level

A) $500

B) $2,000

C) $15,000

SAH – HM funding level

A) $500

B) $2,000

C) $15,000

Billing Information

Billing Agency

Billing Contact Name

Billing Email Address

Urgency

High

Moderate

Low

Feedback Required

Yes

Medical Details

To proceed, you must either provide your Medical Diagnosis, upload relevant Medical Documentation, or both.

Diagnosis / PMHX

Attach a Document (MAC ax, SAH Care Plan, Goals, GP Health Summary, Other)

Drop files here or

Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 10 MB, Max. files: 4.

Which service are you seeking?

Please select at least 1.

Groups

A 2 hour weekly, 7-week evidence-based, education and activity program designed to help older adults improve strength, balance and confidence while reducing their risk of falls

Stepping On

A 2 hour weekly, 7-week evidence-based, education and activity program designed to help older adults improve strength, balance and confidence while reducing their risk of falls

A fun, supportive 45-minute weekly exercise class designed to build functional strength, improve balance and support confident movement

Active and Able

A fun, supportive 45-minute weekly exercise class designed to build functional strength, improve balance and support confident movement

Individual Supports

Physiotherapy

Our physiotherapists can help with mobility, balance, and strength; fall prevention; pain and injury management; hydrotherapy; assistive technology prescription; and exercise programs to support safe, independent functioning at home.

Physiotherapy – Reason for referral

Physiotherapy Location

Home Visit

Telehealth

Clinic

Exercise Physiology

Our exercise physiologists can help with fitness, endurance, and wellbeing assessments and training; exercise programs including hydrotherapy; falls prevention; cardiorespiratory health, bone density, and diabetes management; and neurological rehabilitation.

Exercise Physiology – Reason for referral

Exercise Physiology Location

Home Visit

Telehealth

Clinic

Occupational Therapy

Our occupational therapists can help with independent living assessments and therapy, assistive technology and home modification scripting, falls prevention, and driver screening; cognitive, sensory, and neurological rehabilitation; continence, dementia, pain, and oedema management; and transfer and manual handling planning.

Occupational Therapy – Reason for referral

Occupational Therapy Location

Home Visit

Telehealth

Clinic

Speech Pathology

Our speech pathologists can help with swallow assessment and management, communication assessment and therapy, voice and speech strengthening, assistive technology scripting, and support for dementia-related and cognitive-communication changes, including communication partner education and training.

Speech Pathology – Reason for referral

Speech Pathology Location

Home Visit

Telehealth

Clinic

Social Work

Our social workers can help clients navigate complex situations, systems, and personal circumstances, including counselling and emotional support, advocacy and system navigation (aged care, health, and community services), carer and family support, and safeguarding and crisis support.

Social Work – Reason for referral

Social Work Location

Home Visit

Telehealth

Clinic

Dietetics

Our dietitians can help with diet and nutrition assessments, healthy eating plans for weight management, and condition-specific advice to promote health and wellbeing.

Dietetics – Reason for referral

Dietetics Location

Home Visit

Telehealth

Clinic

SSRG Home Visit Safety Policy is as follows:

All pets must be restrained during visits.
Homes must be smoke free during staff visits.
Aggression, abuse, and harassment are not tolerated.
All safety issues identified must be addressed or mitigated prior to staff attendance.
Visitors are to be restricted during visits.
Staff must have access to emergency use of telephones.
Access doors need to remain unlocked during visits.

For this referral to be accepted, the Risk Assessment below needs to be completed for either the Home Visit or In Clinic appointment.

For Home Visit Appointments

Consent*

Pre-Visit: Does the client consent to the home visit?

Yes

Comments/ Actions Taken

Social*

Pre-Visit: Does anyone else reside in the home or will anyone else be present during home visits?

Yes

Comments/ Actions Taken

Personal Safety*

Pre-Visit: Is there a risk to our staff member’s personal safety?

Unrestrained pets
History or risk of aggression, abuse or violence from client or anyone else in the home?
Drug or alcohol use
Mental Health conditions
Behavioural support plans
Criminal History
Contagious conditions (e.g., HIV, staph, Hepatitis)
Cytotoxic medication use
Weapons

Yes

Comments/ Actions Taken

Access*

Pre-Visit: Is external and internal access to the property safe?

Isolation
Unsealed roads
Phone coverage/home phone access
Parking
Key Safe (code)
Slip or trip hazards
Overgrown foliage
Clutter/hording/squalor
Vermin
Smoking

Yes

Comments/ Actions Taken

For Clinic Appointments Only

Personal Safety

Is there any client risk of :

History or risk of aggression, abuse, or violence
Drug or alcohol use
Mental Health conditions
Medical Conditions
Behavioural support plans
Criminal History
Contagious conditions (e.g., HIV, staph, Hepatitis)
Cytotoxic medication use

Yes

Comments/ Actions Taken