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Complex Residential Support

Complex Residential Support

The Complex Residential Support (CRS) Program provides medium and long term, 24/7 complex residential support, within a recovery orientated framework. The service delivery model is based on holistic, psychosocial rehabilitation.

Through the provision of accommodation to assist individuals in stabilising their mental health in a safe holistic environment the CRS Program is intended for people with moderate to severe mental illness who face challenges living safely in the community.

TeamHEALTH Residential Referral Form - Submit Online

CLIENT CONSENT

I consent to this referral. I understand that this information will be stored on the TeamHEALTH system and that my details will be de-identified if they are used in reporting. I give permission for TeamHEALTH to discussion this information for the purposes of establishing and receiving supports. For more information, please refer to our Privacy policy - teamhealth.asn.au/privacy

PARTICIPANT INFORMATION

Participant Name:

Preferred Name

Date of Birth

Gender

Email Address

Contact Phone Number:

Address

Country of Birth

Main language spoken at home

Indigenous status

REFERRAL INFORMATION

Current mental health concerns and/or diagnosis

Reason for Referral/ How can TeamHEALTH support the referee?

Name of person completing referral

Relationship to participant

Referrer email address

Referrer contact number

ADDITIONAL INFORMATION

NDIS Plan in place? YesNo

Accessed TeamHEALTH Supports previously? YesNo

Any physical health concerns?

Is the referee independent in activities of daily living (ADL)? YesNo

CURRENT MEDICATIONS

Please list any current medications

Risk Information

Word, Text and PDF file formats accepted (5MB limit)

Do you need emergency help?

NT Mental Health Line

Ph: 1800 682 288

Lifeline

Ph: 13 11 14
www.lifeline.org.au

Emergency Services

Ph: 000

Kids Helpline

Ph: 1800 55 1800
www.kidshelpline.com.au

Suicide Call Back Service

Ph: 1300 659 467

Headspace

Ph: 1800 650 890
www.headspace.org.au