SLHD Logo         Naamuru Parent and Baby Unit Referral Form

Naamuru Parent and Baby Unit
Referral Form

* Required Fields. Please submit your application by clicking the 'SUBMIT' button.

 

Please complete the referral form below, ensuring that all mandatory sections are completed.

Please note the Parent and Baby Unit is a tertiary inpatient unit and does not have an acute response service.           

If urgent acute or crisis intervention is required:

  •   ring 000 for emergency services or
  •   attend the nearest hospital emergency department or
  •   ring the Mental Health Telephone Access Line on 1800 011 511 for immediate assessment and support

If you have a Mental Health Assessment document you will have the opportunity to upload it during this referral.

Please read the referral guideline prior to completing this referral form.

+/-

Referrer details

+/-

Client information

Male
Female
Self-identified gender
Yes       No
Aboriginal : Yes       No       Unsure
Torres Strait Islander : Yes       No       Unsure
Yes       No
Yes       No
Voluntary       Involuntary       CTO
Yes       No
+/-

Infant Details

Male       Female

Male       Female

Male       Female

Yes       No
+/-

Other Children

Yes       No
Male       Female

Male       Female

Male       Female

Male       Female

+/-

Family or Friends Support Network

Yes
No



+/-

Professional Networks - GP Details

Yes
No
Yes
No




+/-

Reason for Referral

Please make sure that your attached file
do NOT include any special character (! + ( ) , * : etc.)
Yes
No





Yes
No
Yes
No
+/-

Parent and Child Safety

Yes
No
Not sure


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Page Last Updated: 23 June, 2022