Community Nursing Forms
Application for Exceptional Case Status
Applications for Exceptional Case Status must be completed on the ‘Application for Exceptional Case Status’ form and Attachments included where required.
All relevant Attachments or Additional Travel forms must also be completed with an application, interruption to care, extension or variation, if required.
If required, any relevant attachments (below) must also be completed:
Application for Additional Travel for Exceptional Case Status or Schedule Fees
Exceptional Case Status
Notification of Interruption to Care
Variation or Extension
Palliative Care Forms
Deteriorating or Terminal Notification Form
The Palliative Care Phase – Deteriorating or Terminal Notification Form must be completed once for each entitled person for which the DVA-contracted community nursing provider is claiming an Additional Component of Palliative Care - Deteriorating or Terminal. See Guidelines Section 6.3.4.3.2 and 6.3.4.3.3
Overnight Nursing Care Form
The Palliative Care Overnight Nursing form is used by providers to apply to the ECU for an entitled person in the terminal phase of their disease, who requires overnight nursing care in their place of residence in the short term and who meets the criteria to receive overnight nursing care. See Guidelines 6.3.4.3.4 Palliative Care – Overnight nursing care and Attachment A – 1.2.1.5 Palliative Care – Overnight Nursing
Coordinated Veterans' Care Program Community Nursing Feedback to LMO/GP