Considerations for the transfer of care from NCVH begin from the initial multidisciplinary session. Planning incorporates strategies for continuing care and treatment in veterans’ local communities, in partnership with the veteran, family and carers and primary healthcare providers.
A unified transfer of care summary encapsulating care provided at NCVH is created with input from all members of the multidisciplinary team. The summary is provided to the veteran, their family and carers, GP, primary healthcare providers and community allied health services.
A follow-up is scheduled between the Case Manager, veteran and primary healthcare providers after the transfer of care. This is an opportunity to review the efficacy of treatment and to assess if further care is required at NCVH.
A range of services will be considered for transfer of care including: