CHC Request Complex Healthcare Service
*
This form is for specific requests for a Complex Healthcare service related to a singular Participant. If you require generalised staff training, please visit
our Courses page
to book or enquire.
Your Details
First Name
*
Last Name
*
Email
*
Phone
*
Participant Details
Participant Name
*
Name of the individual to whom care is provided
Please provide the name as Firstname Lastname, for example: Robin (Firstname) Bisley (Lastname) would read
Robin Bisley
Use ONE NAME only (no multiple names like John Smith, Gerry Harlow, and Mel Farnham, please)
If you want to provide
general training
to your staff, please stop filling out this form and
visit our Courses page
to book or enquire.
(one name only please)
What's your relationship to the Participant?
*
Make a selection
Service Provider Representative
Support Worker or Carer
Coordinator of Supports
Private Individual acting on behalf of Participant
I am the Participant (self-managed)
Describe any health needs or conditions relevant to the person's support.
Plan and Training
What kind of Complex Healthcare Plan is required?
*
Please note:
if no plan is selected, a current plan, dated within twelve (12) months of this form submission and written by an appropriate health care professional, must be provided before training can commence.
New Plan
Update Plan
No Plan
What kind of training is required?
*
Select
Client Specific Training
to arrange individual healthcare staff training
Select
Register Annual Recredentialing
to arrange multiple staff training that recurs annually
Select
None
if no training is required
Make a selection
Client Specific Full Credentialing
Client Specific Annual Recredentialing
None
What Complex Healthcare needs would you like to address?
Please note: carers in Tasmania are
required
to hold certification in
Assist Clients with Medication
. Please arrange separate training for this if needed from our general
Course Request form.
Select as many courses as needed.
If Other is selected, please specify what's needed in the comments below.
Make a selection
Acute Management of Anaphylaxis with Auto-Injector
Bowel Care
Enteral Care
Epilepsy and Seizure Care
Manage Diabetes
Respiratory Care
Stoma Care
Urinary Care
Other
How many staff do you want to train?
Enter the number zero if not yet known
Please list the staff names, email address and mobile number, one per line
For example:
Rudy Pond rpond@email.com 0455444333
Amy Frazer afrazer@email.com 0455222111
Leslie Rose lrose@email.com 0455111999
Where would you like the training to occur?
Make a selection
Medecs Learning Devonport
Medecs Learning Hobart
Medecs Learning Launceston
Virtual via Video Conferencing
Our Location
Address
City
Postcode
Please enter any additional information
If Other was selected for Training above, please specify what's needed here
Please press the Submit button
once only
. Multiple clicks are not needed.
Submit