Entering the Service Application Details for Palliative Services (AIC-Home/Hospice)

Note

Click View Case Info to obtain an overview of the patient's current and previous referrals created. Also, the telephone and FAX numbers are provided for the healthcare professionals to make any enquiry pertaining to the referral services.

Service type selected at the time of referral creation is auto-populated in this field.

For community hospital service application, it is displayed as follows:

Palliative (AIC-HOME/HOSPICE)

*Service selection

The service displayed can be one of the following:

• AIC-HOME
  AIC-HOME option is enabled only for certain hospitals. During referral creation, when you select the referral type (Consent For Create Referral > Referral Type Selection), you can see the AIC-HOME details in the bottom-left of the page.
• Hospice
  You can select one of the following:
   > Hospice Day Care
   > Hospice Home Care
   > Hospice In-patient

*Assigned Service Provider

Select the assigned service provider hospital from the list.

AIC-Home Service:

*Reason for AIC-HOME service

Select the reasons (check boxes) listed for AIC-HOME services:

• 1- Prognostication
• 2 - Patient/family preferred place of care is home
  3 - Patient/family is agreeable to palliative goal of care
• 4 - Patient and/or family is aware of objectives of the HOME Programme and agreeable to the referral.
  All the criteria must be satisfied.

*Assigned Service Provider

Select the assigned service provider hospital from the list.

You can select from the following:

• Pain and Symptom
• Psychosocial Support
• Shared Care
• Terminal Care
• Drug Titration
• Others

Additional information for hospice referral

a) You can enter the following details:

• *Referring Consultant/Register/GP

• Hospital/Dept/Clinic

• Other consultants involved:

b) Select Yes or No for the following:

• *Is Hospital Palliative Care team involved?
• *Is Patient currently under a hospice service
• *Has Patient/family member been informed of referral

c) Select the following (check boxes), if applicable:

• *The following have been informed of diagnosis:        
  > Family
  > Neither
  > Patient

• *The following have been informed of prognosis:

         > Family
         > Neither
         > Patient

• Does Service Include COPD ICP

Current Location of Patient:
*Location of Patient

You can select the current location of the patient as follows:

• Home -- You must select one of the following for home address:
    > NA -- not applicable
    > NRIC Address -- The patient's NRIC address is populated.
    > Non NRIC address -- The patient's non-NRIC address needs to be entered.

• Hospital -- You must provide the following details:
    > Expected Discharge Date
    > Hospital Type
• Institution -- You must select the institution from the list provided.

You can specify if the patient is known to other community services as follows:

• NA -- Not Applicable.
  You are not required to fill any details.
• Yes -- You are required to mention the community services in the text box provided.
• No -- The patient is not known to any community services.

Known to MSW / CM/ ACTION TEAM

Is patient known to :

a) You can select if the patient is known to the following:

• MSW
• Case Manager
• Action Team
• Others

b) You can further provide the *Name, *Telephone, *Designation, *Email and so on.

c) To add the details, click Add.

Rehab
Referral

Has patient been referred for therapy

You can choose from the following therapies:

• Physiotherapy
• Occupational Therapy
• Speech Therapy

		Note
		Selecting these therapies, enables the PT, OT and ST tabs for entering further information.

Patient's TCU

Patient requires follow up at OPD/Specialist Clinic?

You can select Yes or No:

Patient requires follow up at OPD/Specialist Clinic.

Financial Information

You can select one of the following:

• Not applicable --- You are not required to enter further information.
• The applicant is on Public Assistance (PA Ref no.) -- Patient is on public assistance and you can provide the PA Ref no. and CDC.
• The applicant is on Medical Fee Exemption Card (MFEC No.) -- Patient is exempted from medical fees payment. You can provide the MFEC No.

Brief Social History

Under social history, you can enter the patient's biography, family history / social support and issues.

Also, you can enter current care management, primary caregiver and experience of care giving.

Additional Information

Any additional information required to be mentioned in the service application can be entered in the Other Remarks textarea.

Note

Note

Note

The mandatory fields that are not entered properly are indicated with asterisks (**). A message is displayed on the top of the page to enter the required fields.