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Rehabilitation referral

Rehabilitation referral

Worker details

Worker first name *
Worker surname *
Sex
Address *
Suburb *
Postcode *
Phone
Date of birth
Nature of injury *
Date of injury
Claim number
 

Employer details

Company name
Rehabilitation coordinator
Address
Suburb
Postcode
Phone
Email
 

Insurer details

Insurer name
Phone
Email
 

Medical details

Treating doctor
Phone
Email
Liability status
Work status
Previous rehab provider involvement
 

Service requested

Rehabilitation
Work Assessment
Vocational Assessment
Functional Assessment
Ergonomic Assessment
Any special needs?
 

Referrer details

Name
Phone
Email

Training news

2012 Training Calendar


MADRIG - Wednesday February 8th 2012
9am to 11am - Topic TBA

Introduction to RTW Coordination (WorkCover approved)
Tuesday 1st May & Wednesday 2nd May 2012 9am to 5pm

Advanced RTW Coordination (WorkCover approved)
Tuesday 2nd August 2012 9am to 5pm

DRUG & ALCOHOL Policy Workshop
Wednesday 6th June 2012 9am to 1.30pm

DRUG & ALCOHOL - Dealing with an Intoxicated Worker -
Wednesday 4th July 2012 9am to midday

Injury Management Training for Supervisors - Contact us for further information

**REGISTER YOUR INTEREST HERE OR ASK FOR MORE INFORMATION


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