Diabetes Programs and Group Education Referral Form

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 (for insulin pen users only) - Dose Adjustment for Normal Eating - an in-depth program on insulin adjustment for people living with type 1 diabetes. Avaliable online for F2F.
Beat It! - 8-week exercise and lifestyle program to improve diabetes management & 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.
CarbSmart - Learn about carbohydrates, when to eat them and which ones are better for you.
ShopSmart - Learn how to read nutrition info, with real products to look at and compare.
FootSmart - Build the skills you need to take care of your feet. Put your best foot forward.
MedSmart - Learn about medication, why to take them and how to develop a medication plan.
LISTEN - One-on-one program to manage diabetes-related stress and improve emotional wellbeing.
Baby Steps - Online support program for women previously diagnosed with gestational diabetes.

  Note: Some programs require patients to be registered with the NDSS to attend. All programs are free.
How do these programs complement the GP Chronic Conditions Management Plan (GPCCMP) Visits?
A GPCCMP is not required. Attending a program does not impact on the five allied health individual visits or eight group program attendances allocated to the person with diabetes. Self-management education has 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:
		Fax to 9221 1183   |   Email: bookings@diabeteswa.com.au   |   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>
Email: <PtEmail>		Medicare: <PtMCNo>	NDSS #: <Patient NDSS #:>
Address: <PtAddress>

Refer to:
Free Group Program: <I would like to refer to Free Group Programs>
Individual Support: <I would like to refer for individual support options:>

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Diabetes WA | P.O. Box 1699 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

Health Professional Signature: 	Date: <TodaysDate>