Leave this field empty
Referral Details
Tell us who is making the referral and
how urgently support is required.
Participant Details
Basic participant and representative
information.
Funding & Current Situation
Tell us about the participant's current SIL funding
and living situation.
Plan Management
Select
NDIA Managed
Plan Managed
Self-managed
Mixed
SIL / Home & Living Status
Select
Approved
Pending
Under Review
Not Yet Approved
Unsure
Approved Support Ratio
Select
1:1
1:2
1:3
2:1
Other
Overnight Model
Select
Inactive Sleepover
Active Overnight
Awake Support
To Be Confirmed
Current Accommodation
Select
Family Home
SIL
SDA
Hospital
Rehab
Private Rental
Temporary
Other
Expected Move / Discharge Date
Reason for Seeking SIL
Urgent Discharge / Homelessness Risk
Select
Yes
No
Not Known
Housing & Support Needs
Tell us about preferred locations, accessibility
requirements and the participant's overall support needs.
Medication Support
Select
Independent
Prompting
Assistance
Administration
PRN Support
Overall Daily Living Support Level
Select
Mostly Independent
Prompting Required
Partial Assistance
High / Full Assistance
Additional Support Details
Other Relevant Medical / Support Information
Risk & Household Matching
Provide any important information that may affect
safety, support planning or household compatibility.
Behaviours of Concern
Select
No
Yes
Behaviour Support Plan
Select
Current
In Development
Not Applicable
Unknown
Brief Description / Known Triggers
Restrictive Practices
Select
No
Yes / Authorised
Yes / Status Unclear
Unknown
Priority Risks / Important Safety Information
Comfortable Living With Others
Select
Yes
No
Unsure / Needs Assessment
Smoking Preference
Select
Non-smoker
Smoker
Can Live With Smoker
Cannot Live With Smoker
Pets
Select
Has Pet
Likes Pets
No Pets Preferred
Animal Allergy / Fear
Sensory / Compatibility Considerations
Documents, Goals & Consent
Provide any available supporting documents and
confirm consent before submitting the referral.
What Matters Most to the Participant?
By submitting this referral, the referrer confirms
that the information is being shared with appropriate
authority for the purpose of assessing potential
Supported Independent Living services and
accommodation suitability.
← Back
Continue →
Submit Referral
