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Catastrophic Injuries Support Scheme (CISS) Referral

If you require further assistance completing a referral, call us at 1800 000 677, email our Intake Team, or lodge an enquiry online.

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Location

Preferred service location *

ORS office
Telehealth
Private residence
Other

Initial Organisation

Initial Phone *

Initial Contact Name *

Initial Email *

Initial address *

Choose the closest ORS location *

Services Required

Services available via Telehealth *

Positive Behaviour Support
Psychology
Occupational Therapy
Speech Pathology
Dietetics

Positive Behaviour Support Services *

Positive behaviour support assessment and plan.
Positive behaviour support, assessment, plan and ongoing intervention including stakeholder and family training

Psychology Services *

Psychological capacity assessment and report.
Psychological capacity building / psychological counselling.

Occupational Therapy Services *

Functional assessment and report outlining recommendations.
Sensory assessment and report.
Home and living assessment (Supported Independent Living/Specialist Disability Accommodation/Independent Living Options) and report.
Skill building therapy.

Speech Pathology Services *

Communication assessment and report outlining recommendations.
Communication assessment, report, and ongoing therapy
Skill building therapy.
Swallowing assessment and meal time management plan.
Swallowing and communication assessment with meal time management plan and communication recommendations.
Swallowing and communication assessment with mealtime management plan and ongoing therapy

Dietetic Services *

Dietetics assessment and report outlining recommendations.
Dietetics assessment, ongoing therapy, and report.

Services Available at Jandakot *

Positive Behaviour Support
Psychology
Occupational Therapy
Speech Pathology
Dietetics

Services Available at Morley *

Positive Behaviour Support
Psychology
Occupational Therapy
Speech Pathology
Dietetics

Services Available at Stirling *

Positive Behaviour Support
Psychology
Occupational Therapy
Speech Pathology
Dietetics

Positive Behaviour Support Services at Jandakot *

Positive behaviour support assessment and plan.
Positive behaviour support assessment, plan and ongoing intervention including stakeholder and family training.

Positive Behaviour Support Services at Morley *

Positive behaviour support assessment and plan.
Positive behaviour support assessment, plan and ongoing intervention including stakeholder and family training.

Positive Behaviour Support Services at Stirling *

Positive behaviour support assessment and plan.
Positive behaviour support assessment, plan and ongoing intervention including stakeholder and family training.

Psychology Services at Jandakot *

Psychological capacity building / psychological counselling.
Decision-making capacity assessment and report.
IQ assessment and report.
Psychological capacity assessment and report.
Neuropsychological assessment and report.
Psychoeducational assessment and report.

Psychology Services at Morley *

Psychological capacity building / psychological counselling.
Decision-making capacity assessment and report.
IQ assessment and report.
Psychological capacity assessment and report.
Neuropsychological assessment and report.
Psychoeducational assessment and report.

Psychology Services at Stirling *

Psychological capacity building / psychological counselling.
Decision-making capacity assessment and report.
IQ assessment and report.
Psychological capacity assessment and report.
Neuropsychological assessment and report.
Psychoeducational assessment and report.

Occupational Therapy Services at Jandakot *

Skill building therapy.
Functional assessment and report outlining recommendations.
Assistive technology assessment and report outlining recommendations.
Home modification assessment and report outlining recommendations – basic.
Home modification assessment and report outlining recommendations – complex.
Manual handling assessment, report and training.
Sensory assessment and report.
Home and living assessment (Supported Independent Living/Specialist Disability Accommodation/Independent Living Options) and report.

Occupational Therapy Services at Morley *

Skill building therapy.
Functional assessment and report outlining recommendations.
Assistive technology assessment and report outlining recommendations.
Home modification assessment and report outlining recommendations – basic.
Home modification assessment and report outlining recommendations – complex.
Manual handling assessment, report and training.
Sensory assessment and report.
Home and living assessment (Supported Independent Living/Specialist Disability Accommodation/Independent Living Options) and report.

Occupational Therapy Services at Stirling *

Skill building therapy.
Functional assessment and report outlining recommendations.
Assistive technology assessment and report outlining recommendations.
Home modification assessment and report outlining recommendations – basic.
Home modification assessment and report outlining recommendations – complex.
Manual handling assessment, report and training.
Sensory assessment and report.
Home and living assessment (Supported Independent Living/Specialist Disability Accommodation/Independent Living Options) and report.

Speech Pathology Services at Morley *

Skill building therapy.
Swallowing and communication assessment with meal time management plan and ongoing therapy.
Communication assessment and report outlining recommendations.
Communication assessment, report and ongoing therapy.
Assistive technology and augmentative and alternative communication (AAC) assessment and report outlining recommendations.
Swallowing assessment and meal time management plan.
Swallowing and communication assessment with meal time management plan and communication recommendations.

Speech Pathology Services at Stirling *

Skill building therapy.
Swallowing and communication assessment with meal time management plan and ongoing therapy.
Communication assessment and report outlining recommendations.
Communication assessment, report and ongoing therapy.
Assistive technology and augmentative and alternative communication (AAC) assessment and report outlining recommendations.
Swallowing assessment and meal time management plan.
Swallowing and communication assessment with meal time management plan and communication recommendations.

Dietetic Services at Morley *

Dietetics assessment, ongoing therapy and report.
Dietetics assessment and report outlining recommendations.

Dietetic Services at Stirling *

Dietetics assessment, ongoing therapy and report.
Dietetics assessment and report outlining recommendations.

Dietetic Services at Jandakot *

Dietetics assessment, ongoing therapy and report.
Dietetics assessment and report outlining recommendations.

Participant Details

Pronoun

Preferred name

Full Name *

First

Last

Date of birth *

Gender *

Phone *

Email *

Reference number *

Residence type *

Residence organisation

Address *

Origin *

First Nations People
Culturally and linguistically diverse
N/A

Referrer Information

Organisation

Phone *

Contact name *

Referrer Email *

Referrer address *

Injury, Diagnosis, and Background

Diagnosis details *

Documentation

File Upload

Click or drag files to this area to upload. You can upload up to 25 files.

Accepted file types: .xlxs, .jpg, .jpeg, .doc, .docx, .pdf, .png
Max Upload: 25mb.
Please Note: If you encounter upload issues, please remove the affected file/files and retry uploading.

Appointment Information

Interpreter required *

Yes
No

Language and dialect requirements *

Communication preferences or requirements *

Yes
No

Communication requirements *

Access requirements *

Yes
No

Access requirements *

Appointment Contact (if not the participant)

Phone

Email

Appointment Attendees (in addition to the participant)

Appointment preferences *

Preferred time
No preference

ORS will try and ensure we meet the participant’s preferences where we can. However, some times are particularly popular, which may make it harder to organise at these times. In these cases, we will be in touch to discuss options.

Day *

Monday
Tuesday
Wednesday
Thursday
Friday

Time *

9am-10am
10am-11am
11am-12pm
12pm-1pm
1pm-2pm
2pm-3pm
3pm-4pm
4pm-5pm

Appointment comments

Are there any preferences for a consultant? *

Yes
No

Preferred Consultant Name

Consultant Gender

Risks and Safety

Are there any court orders applicable bail, parole, family or domestic violence order etc.? *

Yes
No

Custody/Court Information *

Has the participant ever been physically aggressive towards allied health, medical or support staff? *

Yes
No

Aggressiveness Information *

Has the participant been incarcerated in a prison, juvenile detention centre or spent time in a forensic hospital for a violent or sexual offence? *

Yes
No

Incarceration Information *

Is the participant currently engaging in alcohol or drug misuse? *

Yes
No

Substance Information *

Are there any known risks for visiting the participant in their own home? *

Yes
No

Risk Information *

Is there any other information we need to know about the participant e.g., triggers for aggression or topics/activities/items that might make them upset? Are there any specific likes or dislikes? *

Yes
No

Likes or Dislikes *

Further Information

Further Information

One minute application!

Join the team today, transform lives tomorrow.

Apply now, CV not required on application.

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Name *

Phone *

What discipline/division are you interested in

Email *

Suburb *

State *

What is your ideal role? *

CV Upload (Optional)

I would like to receive emails regarding future employment opportunities available at ORS. *

Submit Feedback

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Feedback Type *

Compliment
Feedback
Complaint

Name *

Phone *

Email *

ORS Location

Subject *

Comment or Message *

File Upload (Optional)

Click or drag files to this area to upload. You can upload up to 10 files.

Would you like ORS to contact you about your feedback or suggestion? *

Yes
No

Preferred contact method?

Mobile
Email

How can we help?

Needing more information regarding ORS’ services contact our Intake Team and they will be in touch shortly.

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Full name *

Phone *

Services Required *

Email *

Suburb

Your Comments

How did you hear about ORS *

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