Request for palliative care practice visit

North Western Melbourne Primary Health Network has partnered with the North and West Metropolitan Region Palliative Care Consortium to offer general practices the opportunity to connect with local community-based palliative care providers.

General practices can request a visit from a community palliative care team member to provide information, education, and support, and help improve understanding and access to community palliative care services.

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* 1. Practice name

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* 2. Practice contact details

Contact person *

Number

Street

Suburb

Post Code

Email Address

Phone number

Preferred contact time *

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* 3. Please select areas of interest you would like covered in your visit.

Role of community palliative care services

When to refer

Where to refer

How to refer

Anticipatory prescribing

Pain management in palliative care

Caring for a dying patient at home

Psychosocial support for patients and families

Roles and responsibilities for medical certificate of cause of death (MCCD)

Palliative care in aged care

Having difficult conversations

Other (please specify)

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* 4. Please rate your practice's current level of awareness and engagement with community palliative care.

Low

Moderate

High

Clear

i We adjusted the number you entered based on the slider’s scale.

Request for palliative care practice visit

Question Title

* 1. Practice name

Question Title

* 2. Practice contact details

Question Title

* 3. Please select areas of interest you would like covered in your visit.

Question Title

* 4. Please rate your practice's current level of awareness and engagement with community palliative care.

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* 5. Community palliative care providers are determined by local government area (LGA). Please select the LGA your practice is located in.