Notification of discharge template
This tool was developed as part of the Eastern Metropolitan Region AOD Service Coordination Project.
Please refer to http://www.health.vic.gov.au/aod/pubs/index.htm for further information
Date: ……../……../……..
Dear ……………………………………………………………..
Service provider: ……………………………………………………………………………………………….
Client Name:
Gender:
Male / Female
Date of Birth:
Address:
Contact Number/s:
Consent to share information gained from client: Yes verbal / Yes written / No
Your client completed their involvement with the ….XXXXXXXX… Program on (discharge date).
The following services have been engaged to assist with ongoing management:
Agency
Contact Number
Services
Ongoing issues that may require follow up are:
……………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………….
Other relevant information:
………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………
If you have any comments or questions, please do not hesitate to phone us.
Yours sincerely,
Name of clinician
Role, Service
Phone: …………………………………………………… Fax: ……………………………………………..
Email: ……………………………………………………………………………………………………………
Kate Pascale & Associates 2011
Developed as part of the EMR AOD Service Coordination Project