CALHN Consumer, Carer & Community Register Nomination Form

Join the CALHN Consumer, Carer and Community Register

CALHN's commitment:

A priority for Central Adelaide Local Health Network (CALHN) is to be a leader in clinical care. Improving the health and wellbeing of our community requires that we genuinely engage with people who use our services, those that care for them or provide significant support and our community.

We believe that without engaged consumers and authentic partnerships the delivery of accessible, safe, responsive, high-quality and high-value healthcare will no be fully realised.

Joining the Consumer, Carer and Community Register:

Joining this 'Register' is a way for you to become actively involved in making care better at CALHN. Opportunities for involvement across the network are shared with Register members.

By capturing your skills, interest areas and experience we are better able to match you to these opportunities, support your development as a consumer, carer or community representative and ensure that peoples' voice and input is strengthened and valued by the organisation.

Further information and questions:

If you have further questions please contact the consumer Experience Team on makingcarebetter@sa.gov.au or by calling 7074 1377.

Attend an Information Session:

The next Consumer, Carer and Community Information Session for people wanting to learn more about partnering with and getting involved in making care batter at CALHN will be held on Thursday June 20th, 10am-12pm.

Register by emailing makingcarebetter@sa.gov.au or by calling 7074 1377.

Question Title

* 1. Personal details:

Name

Postal Address

Suburb

Post Code

Email Address

Phone Number

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* 2. Preferred method of communication:

phone

text/SMS

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* 3. Do you identify as any of the following:

Aboriginal

Torres Strait Islander

LGBTQIA+

Culturally or Linguistically Diverse

refugee background

living with a chronic health issue

carer or significant support person of someone with a chronic health issue

having a physical disability

having an intellectual disability

having a psychosocial disability

carer or significant support person of someone with a physical or intellectual disability

having lived experience of mental health issues as a consumer

having lived experience of mental health issues as a carer or significant support person

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* 4. Skills you have and areas of involvement you are interested in:

service design and planning

policy development or review

being a member of consumer committee's

staff recruitment

staff education and training

sharing your story with others

review and feedback on written materials

attending occasional meetings and workshops relevant to consumers

being a consumer advocate or representative on organisational committee's

specific projects

consumer newsletter

being informed about what is happening at CALHN and relevant issues for consumers, carers and the community

attend consultations

online ways of being involved only

Please tell us about your experience in these areas

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* 5. Areas of interest and experience in health care:

consumer and community engagement

aged care

child and adolescent health

cancer care

health and medical research

Aboriginal / Indigenous health

disability

alcohol and other drugs

mental health

heart and lung health

renal health

surgical area

allied health - eg physio, psychological, etc

stroke

intensive care

emergency care

rehabilitation services

brain injury

women's health

sexual health

safety and quality issues

LGBTQIA+ issues

palliative care

rural and remote issues

migrant issues

refugee issues

Other areas of interest

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* 6. Why do you want to join the CALHN Consumer, Carer & Community Register?

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* 7. Have you had any training or experience as a health consumer, carer or community representative? Please share below.

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* 8. Can you tell us about your availability for being involved:

weekdays during business hours - flexibly

weekdays during business hours - several hours per month for regular meetings

weekdays after business hours

weekends

out-of-hours online

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* 9. Final confirmation of your interest:

I agree to my information being added to the CALHN Consumer, Carer and Community Register

I agree to my email address being added to the Register List

I agree to receive emails relevant to consumers, carers and community members

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* 10. OFFICE USE ONLY

Check the items relevant to this person.

has attended orientation

has completed confidentiality and conflict of interest paperwork

has received social media policy

has completed identification card paperwork

has attended consumer advocacy training

has been added to the mailing list

further training specific to engagement activities this person is involved in

national police check if deemed necessary for the engagement activities that this person is involved in

Additional notes:

CALHN Consumer, Carer & Community Register Nomination Form

Join the CALHN Consumer, Carer and Community Register

Question Title

* 1. Personal details:

Question Title

* 2. Preferred method of communication:

Question Title

* 3. Do you identify as any of the following:

Question Title

* 4. Skills you have and areas of involvement you are interested in:

Question Title

* 5. Areas of interest and experience in health care:

Question Title

* 6. Why do you want to join the CALHN Consumer, Carer & Community Register?

Question Title

* 7. Have you had any training or experience as a health consumer, carer or community representative? Please share below.

Question Title

* 8. Can you tell us about your availability for being involved:

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* 9. Final confirmation of your interest:

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* 10. OFFICE USE ONLY Check the items relevant to this person.

* 10. OFFICE USE ONLY

Check the items relevant to this person.