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NDIS Online Referral

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Please note that the following information/documents will be needed when completing this referral form:

  • NDIS Number
  • NDIS Plan
  • Knowing if what services are NDIA Managed, Plan-Managed or Self-Managed (outlined in your NDIS Plan)
  • Plan Manager contact and billing details if Plan-Managed
  • Support Coordinator contact details
  • Knowing if your plan is on Proda (old NDIA computer system) or Pace (new NDIA computer system). You would have been advised of this in your most recent Plan Review if you have moved to the new computer system.
Location
Preferred service location
Participant Details
Full Name
Origin
Interpreter required
Communication preferences or requirements
Access requirements
Advocate and Guardian Information
Does the participant have
Referrer Information
Diagnosis and Background
Documentation
Please provide a copy of the most recent NDIS plan and any previous allied health and medical reports, if available.
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.
Risks and Safety
Are there any court orders applicable? e.g., parole, apprehended violence order etc.
Has the participant ever been physically aggressive towards allied health, medical or support staff?
Has the participant been incarcerated in a prison, juvenile detention centre or spent time in a forensic hospital for a violent or sexual offence?
Is the participant currently engaging in alcohol or drug use?
Are there any known risks for visiting the participant in their own home?
Is there any other information we need to know about the client? e.g., are there any topics that may trigger the client to become upset? Any specific likes or dislikes?
Initial Assessment
Appointment preferences
Are there any preferences for a consultant?
Service Agreement
Who will sign the service agreement
Payment Method
Who does ORS invoice? (please select all that apply)
Travel disclaimer
Travel Disclaimer
Further Information

Disclaimer

ORS will attempt to contact the nominated person in the referral from as soon as the referral has been processed to schedule an appointment at the earliest and most convenient time. If we are unable to contact you via telephone and you have indicated a preferred appointment day and time when completing the referral, we will do our best to schedule at, or around this time and send you an SMS and email with these details. If no appointment day and time were indicated on the referral form, we will need to make contact to confirm a suitable day and time for the appointment and will send you an SMS and email which can be responded to outlining preferred days and times. If we do not hear back from you within ten business days after attempting our first contact, we will be required to close the case to make space for other clients requiring ORS Services.

Disclaimer
Disclaimer

If you require assistance completing this referral please call our Intake Team on

1800 000 677

OR enter your details below and a member of our team will contact you shortly.

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