Post-Operative Care Referral

Complete this form to refer a client for specialised post-operative nursing care including wound management, medication support, and recovery monitoring.

Post-Operative Care Referral Form

Referrer Information

Full Name *

Hospital/Clinic *

Position/Title *

Email Address *

Phone Number *

Provider/Registration Number

Patient Information

First Name *

Last Name *

Date of Birth *

Phone Number *

Email Address

Medicare Number *

Hospital UR Number

Emergency Contact *

Emergency Contact Phone *

Home Address *

Patient has a Representative (Guardian, Power of Attorney, or Support Person)

Surgical & Post-Operative Details

Surgery Date *

Discharge Date *

Type of Surgery/Procedure *

Operating Surgeon *

Post-Operative Care Required * (Select all that apply)

Wound Care & Dressing Changes

Surgical Drain Management

Pain Management & Medication

Mobility Support & Physiotherapy

Vital Signs Monitoring

Infection Prevention & Monitoring

Medication Education & Compliance

General Recovery Support

Recommended Visit Frequency *

Expected Duration of Care

Complications or Special Considerations

Current Medications & Pain Management *

Surgeon's Follow-up Instructions *

Client has NDIS Funding

Check this if the client will be using NDIS funding for services

Supporting Documents

Discharge Summary/Surgical Notes *

Upload discharge summary, surgical notes, and post-operative care plan

Medical Records/Imaging

Upload relevant medical records, imaging results, or pathology reports

Additional Information

Consent and Authorization

I confirm that I have the patient's consent to make this post-operative care referral and that all clinical information provided is accurate and current. *

I acknowledge that this information will be used for post-operative care coordination and may be shared with relevant healthcare providers as necessary for continuity of care. *

What Happens Next?

Immediate Review (2 hours)

Our clinical team will review your referral immediately and contact you to confirm receipt and care plan.

Care Coordination (4-6 hours)

We'll coordinate with the surgical team and arrange the first post-operative visit according to discharge instructions.

Care Commencement (Within 24 hours)

Our qualified nursing team will commence post-operative care as per the surgical team's instructions and recovery plan.

Aboriginal and Torres Strait Islander cultural imagery

Acknowledgment to Country

Clinicare QLD acknowledges the First Peoples of this Nation and their ongoing cultural and spiritual connections to the lands, waters, seas, skies, and communities.

We acknowledge First Nations Peoples as the Traditional Custodians and Lore Keepers of the oldest living culture and pay respects to their Elders past and present.

Unity in Diversity • Respect • Recognition

Here for you, here for Queensland. Comprehensive healthcare services across Queensland. From aged care to NDIS support, we're here to help you live your best life.

0428 950 043

Hello@clinicareqld.com.au

Queensland Wide