Diabetes Group Education Services Referral Form
Programs are free for NDSS Registrants. Available online & face to face (depending on program/region). 

DESMOND – Diabetes Education and Self-Management for Ongoing and Newly Diagnosed
- a single-day self-management workshop for helping to take away the guesswork of type 2 diabetes.
MyDESMOND - an adaption of DESMOND - available online at a time that suits them. OzDAFNE@home (for insulin pen users only) - Dose Adjustment for Normal Eating - an in-depth program on insulin adjustment for people living with type 1 diabetes. 
Baby Steps - supporting women previously diagnosed with gestational diabetes.
Beat It! - an 8-week exercise and lifestyle program to improve diabetes management and general health.
Living Well with Diabetes - a session for people who want to better understand and manage their diabetes. Includes practical guidance, time for questions and the latest updates in care.

How do these programs complement the GP Chronic Conditions Management Plan Visits?
Attending a Diabetes WA Group Education program does not impact on the five allied health individual visits or eight group program attendances allocated to the person with diabetes. In fact, the programs have the potential to increase the effectiveness of these allied health visits by activating patients to self-manage their diabetes and create their own care plan.

To refer patients/clients, please complete the details below and return to Diabetes WA by:
1.	Fax to 9221 1183 or
1.	Email to: bookings@diabeteswa.com.au or
2.	Healthlink: DWATEL3H

Referring Health Professional Details:
HP Name: <UsrName>	HP Practice: <LocationName>
Fax: <LocationFax>		Phone: <LocationPhone>	Email: <LocationEmail>

Patient Details: 
Name: <PtFullName>		DOB: <PtDoB>		Phone: <PtPhoneMob> / <PtPhoneH>
Address: <PtAddress>	Medicare: <PtMCNo>		NDSS #: <Patient NDSS #:>
Diabetes Type and Group Programs Applicable: <Diabetes Type: Group Programs>
Discuss individual appointments with a credentialled diabetes educator? <Discuss Individual Appts with Diabetes Educator?>

Stay up to date on Diabetes WA News? <Receive Diabetes WA Health Professional News?> 
Health Professional Signature: 	Date: <TodaysDate>

Diabetes WA | Level 3/222 Hay Street Subiaco, WA 6008 |
P: 1300 001 880 | F: 9221 1183 | E: bookings@diabeteswa.com.au | diabeteswa.com.au
abn 77 867 587 369 acn 610 729 612

The National Diabetes Services Scheme is an initiative of the Australian Government administered with the assistance of Diabetes Australia. For more NDSS information: ndss.com.au