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Call Us: 02 4365 2294

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You can access many of our public and staff policies via these links.

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Innovate Reconciliation Action Plan Feb 2020 – Feb 2022
ISO Accreditation CCPC 2021-2024
Strategic Plan 2022-2024
Service Charter

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Privacy Policy

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167B The Entrance Rd,
Erina NSW 2250
Phone : 02 4365 2294

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Coast & Country Primary Care acknowledges that we work on Traditional Aboriginal land and pay our respects to Elders past, present, and future.

Coast & Country Primary Care embraces diversity.
All welcome here.

CCPC is a registered provider for the National Disability Insurance Scheme (NDIS) and accredited against the NDIS Quality and Safeguards Standards.

CCPC is a certified ISO 9001 Quality Management Systems approved company by QMS Certification Services.

CCPC is registered as a COVID Safe business. We are committed to protecting the community and preventing the spread of COVID-19.

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Aunty Jean's Program Referral Form

Fields marked with an * are required.

PATIENT DETAILS

Name*

DOB*

Address*

Phone*

GP Name/Practice*

Has patient consented to referral?*YesNo

GPMP and/or TCA attached?*YesNo

Has patient had health check ≤ 12 months?*YesNo

If yes, when was this health check?

ELIGIBILITY CRITERIA

Is patient Aboriginal and/or Torres Strait Islander:*YesNo

Patient must have at least ONE of the following conditions:*DiabetesChronic Respiratory DiseaseCancerCardiovascular DiseaseChronic Kidney Disease

Please specify other health condition/s:

Participation in Aunty Jeans Aboriginal Chronic Care Program includes exercise sessions which are supervised by an Accredited Exercise Physiologist. Sub-maximal exercise testing pre and post program will be conducted.

Your patient will be given an individualised exercise program including warm up, aerobic exercises, resistance training, stretching and cool down. All exercises will be performed at a light to moderate intensity. The exercise testing may involve a 6-minute walk test, stationary bike test and a sit to stand test. Should any of the contraindications below be observed exercise will not be undertaken and appropriate care will be provided:

Unstable angina
Symptoms such as chest discomfort, shortness of breath on low activity
Uncontrolled cardiac failure
Severe aortic stenosis
Uncontrolled hypertension (systolic BP ≥ 180mmHg, diastolic BP ≥ 110mmHg)
Acute infection or fever
Resting tachycardia/arrhythmia
Uncontrolled diabetes (e.g. blood glucose < 6mmol/L or > 15 mmol/L)

REFERRER DETAILS

Referrer Name*

Referrer Practice*

Email*

Phone*

Referral Date*

For any enquires regarding referrals, please contact the Chronic Disease Outreach Nurse on 02 4365 2294 or email ccpc@ccpc.com.au

Health on The Streets Referral Form

Fields marked with an * are required.

REFERRER DETAILS

Organisation*

Name*

Phone Number*

Email Address*

PATIENT DETAILS

Name*

DOB

Address/location*

Phone Number*

Usual GP*

GP Practice*

ASSISTANCE REQUIRED

Outreach*

Clinical Care*

Preventative Care*

Other

ADDITIONAL INFORMATION

Current level of engagement with your service (i.e. frequency and length of time)

Please list risks for outreach engagement

Other services/organisations engaged with this person

Priority for support*1. Urgent2. High Priority3. Medium Priority4. Low Priority5. No Priority

Aboriginal and Torres Strait Islander Scholarship Form

Fields marked with an * are required.

Name*

Address*

Contact Number*

Email Address*

Gender Identity*

Do you identify as an Aboriginal or Torres Strait Islander person?*YesNo

Course details and institution*

Year study commenced*

Expected year of completion*

Will you require a placement?*YesNo

How many hours of placement*

Learning institution contact information eg supervisor, student support*

Are these studies full-time or part-time*Full-timePart-time

What learning resources are you planning to use the scholarship funds forLaptopTabletMouse and keyboardTextbooksStationery itemsOther - please specify below

Upload resume (PDF or Word)*

Upload cover letter (PDF or Word)*

Upload confirmation of enrolment (PDF or Word)*

Coast Nutrition Referral Form

Fields marked with an * are required.

REFERRER DETAILS

Referrer Name*

Referral Date*

Referring Organisation*

Phone Number*

Email*

CLIENT DETAILS

Client Name*

DOB*

Aboriginal or Torres Strait Islander Status*AboriginalTorres Strait IslanderAboriginal & Torres Strait IslanderNeitherUnknown/prefer not to say

Medicare Number*

Gender*MaleFemalePrefer not to say

Address*

Phone Number*

GP Name*

GP Practice*

Do you have any concerns for dieticians providing home visits?*

CARER DETAILS (if applicable)

Carer Name

Phone Number

REFERRAL DETAILS

Reason for referral?*

CLIENT INFORMATION

Weight*

Height*

Weight History*

Recent Weight Loss*YesNo

If Yes, how much?

CONFIRMATION OF REFERRAL VIA MyAgedCare (MAC) NATIONAL GATEWAY

Referral submitted to My Aged Care National Gateway on*

MAC Number*

For any enquires regarding referrals, please contact the Team Leader Community Programs on 02 4365 2294 or email ccpc@ccpc.com.au

Your name

Your email

GPRegistered NurseMidwifeRegistered ParamedicPractice Administration

Fields marked with an * are required

First Name*

Last Name*

Phone Number

Email Address*

Area of interest

Upload cover letter (PDF or Word)

Upload resume (PDF or Word)*

.

Fields marked with an * are required

Name*

Profession

Practice

Contact Number

Email Address*

.

Fields marked with an * are required

First Name*

Last Name*

Email*

Phone Number

Area of interest

.