IDENTIFYING CONNECTIONS ACROSS SERVICE PROVIDERS ON HEALTHPATHWAYS
ADVANCE CARE PLANNING AND PALLIATIVE CARE

 
Please answer all questions below.
1


Demographic question - About you and your workplace.
 
1Q1. You are a
   GP
   GP Registrar
   Medical specialist
   Registered/enrolled nurse
   Practice manager
   Allied Health practitioner
   Other (Please specify)
 

2
Q2. Please write below the name of your healthcare provider / practice.
3


Network questions – How you link with others in the pathways.
 
3Q3. Below are the names of agencies/individual clinicians that offer services across advance care planning and palliative care pathways. Please indicate which ones you are AWARE of.

Note: if you don’t select any agencies/individual clinicians below you will be taken to the final question in this survey.

Palliative Care Services - ACT
3.1  Palliative and Hospice Care
3.2  Covenant Care Day Hospice
3.3  Home Based Palliative Care
3.4  Palliative Care Service (Canberra Region Cancer Centre)
3.5  Calvary Public Hospital

Palliative Care Services - NSW
3.6  Southern NSW Local Health District – Community Health Intake
3.7  Dr Suzanne Rainsford – (Cooma) Palliative Medicine Specialist

Respite Care - ACT
3.8  Belconnen Community Service
3.9  Gungahlin - Communities@Work
3.10  Northside Community Service
3.11  Southside Community Services
3.12  Tuggeranong - Communities@Work
3.13  Weston Creek - Communities@Work
3.14  Woden Community Service
3.15  Carers ACT
3.16  Duo Services Australia
3.17  Kincare Community Services ACT

Respite Care - NSW
3.18  Queanbeyan - Home Care
3.19  Ronald McDonald Family Retreat Fiona Lodge
3.20  The OTIS Foundation
3.21  Yurana Cancer Kids Holiday Homes

State based agencies - ACT
3.22  Palliative Care ACT

State based agencies - NSW
3.23  Palliative Care NSW
 

4
Q4. Are there any 'other' agencies/individual clinicians that can offer services across the advance care planning and palliative care pathways. List up to three names


4.1  Other 1  
4.2  Other 2  
4.3  Other 3  
 


 
   

 
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