Transfer of Care begins from the initial multidisciplinary team session. Transfer of Care incorporates strategies for continuing care and treatment in veterans’ local communities, in partnership with the veteran, their family and carers and primary healthcare providers.
All specialists involved in a veteran’s care contribute to a unified transfer of care summary encapsulating the care that has been provided at the Centre. This summary is provided to the veteran, their GP and community allied health services.
After transfer of care, a scheduled follow-up contact occurs between the Case Manager, veteran and primary healthcare providers to review the efficacy of treatment. Further assessment or care by the Centre may be required.
The Centre may refer a veteran to a range of services upon transfer of care: