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Complex Care Supplementary Form

This form helps us provide safe and personalised care for clients with complex needs. It takes about 8 to 10 minutes and covers consent, NDIS plan detail, support team, and any specific accessibility or communication needs.

Consent and decision-making authority

We need to know who can legally consent to care, treatment, information sharing, and administrative arrangements for this client. Next of kin is not always the legal decision-maker.

Who can legally provide consent for this client?

The client can consent for themselves

Parent or legal guardian

Enduring guardian with health or medical decision-making authority

Appointed guardian with health or medical decision-making authority

Public Guardian or tribunal-appointed guardian

Person responsible under state or territory law

Other authorised decision-maker

Unsure

An enduring power of attorney does not authorise medical or treatment decisions in most Australian jurisdictions. If the client cannot consent themselves and you are unsure who can, please select Unsure and we will clarify before services proceed.

Does the client currently have capacity to make decisions about their care and treatment?

Yes

Unsure

Full name of the person providing consent

Relationship to the client

NDIS plan detail

If the client has NDIS funding, please share the relevant plan details below.

Does the client have NDIS funding?

Yes

Not sure

Support team and billing contacts

These contacts help us coordinate care and ensure invoices reach the right person.

Support coordinator name

Support coordinator email

Nominee or guardian name

Billing contact name

Billing contact email

Referrer

If a clinician, GP, allied health professional, or service has referred this client to Continuum, please share their details so we can keep them informed.

Do you have a referrer?

Yes

Specialists and supports involved

Relevant specialists or supports involved (optional)

Extended needs assessment

These details help our clinicians prepare appointments that are accessible, comfortable, and respectful of the client's needs.