Home Assist Community Services

133 Adelaide Street Maryborough 07/4123 2234

Minor Modifications CHSP, DVA, Private

To be completed by Occupational Therapists for minor modification requests.

“If you are requesting a service for a HOME CARE PACKAGE CONSUMER and YOU ARE NOT THE PACKAGE PROVIDER Please DO NOT COMPLETE this referral form – Your request for service  MUST GO DIRECTLY TO THE HCP PROVIDER FOR APPROVAL in the first instance. Please send all of your relevant documentation to the provider for approval, once this has been reviewed the provider will submit this REFERRAL form and attach any PURCHASE ORDER/SERVICE REQUEST documentation as required to provide your consumer with a service as requested.

Skip to content