Refer to THE SHEPHERD'S HOSPICE, Macdonald Village
Please fill in this form to refer your patient to our Palliative Care Multidisciplinary Team. (It should take about 5 minutes)
For enquiries please email
or call us: 079076906 or 080306748
We will revert to you within 1 working day.
PATIENT CONTACT NUMBER
REFERRAL PHYSICIAN NAME
China-SL Friendship Hospital
34 Military Hospital
Personal (not referred by doctor or nurse)
REFERRAL PHYSICIAN CONTACT NUMBER OR EMAIL
REASON FOR REFERRAL
Please help us by also providing RELEVANT CLINICAL DETAILS in the free text section "Others" e.g. LOCATION, CAUSE, SEVERITY of pain, elaborate on patient's clinical condition if referring for end of life care, or summarise communication to date if referring for goals of care discussion.
Goals of Care Discussion
End of Life Care
What is the Diagnosis?
Organ Failure/End-stage organ disease
Patient has more than one of the above diagnoses
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