Notes to help you complete the Referral form

St Ann's Hospice is dedicated to providing specialist palliative care and support for those people who have a life threatening illness and the people who care for them. However, so that we can continue to provide this level of care, we need to ask for your co-operation in completing this referral form.

The information you provide within this referral form is very important to us and is often the only way we are able to make a decision with regard to your request for a hospice service. Clarity of information assists us in providing a timely response to your request for services therefore we would ask that you provide clear, concise and relevant information to assist us in the processing of your request.

Patients will be admitted for a short period of ongoing assessment and the patients' condition will clearly determine the length of stay and future care needs. However, as you are probably aware, St Ann's Hospice does not provide long term care therefore we would request that, prior to referral, you give due thought as to whether the hospice is the most appropriate place to meet your patients' needs, especially if your patients' condition is relatively stable.

Should you request the deferred waiting list we will hold the referral for a period of 6 months. If during that period the referral is not activated then the application will be removed from the database. Any subsequent request for services will require a new referral form.

For your information, please take a look at the list of Supportive Outpatient services available over the three hospice sites. We would ask that you give careful consideration to these service(s) before completing the form. If you are unsure about any of the services we provide or whether your patient meets the criteria for admission then please ring the relevant hospice site and ask to speak to the Admissions Clerk.