Downloadable Forms

Inpatient unit and community referral forms

Sponsor forms

Gift Aid declaration form 

Volunteers application form 

How to complain

Downloadable Forms
Patient Referrals, Sponsors, Volunteers, Complaints and Equality & Diversity.

Downloadable Forms

In-Patient Unit referral form

Used to refer In-Patients to Kilbryde Hospice.

Referral criteria form

Criteria for the referral of patients to specialist palliative care at Kilbryde Hospice.

Referral form (Non-In-Patient Unit including Day Services, Carers & Outpatients)

Used to refer non-IPU Patients to Kilbryde Hospice.

CLAN (Formally care at home referral form)

Use to refer care at home patients to Kilbryde Hospice.

Gift Aid declaration

An editable Gift Aid Declaration form.

How to raise a concern or complaint about healthcare

We treat complaints seriously and want to ensure that we learn from them, taking action to improve our services.

Volunteer application form

Application form for volunteers.

Equality and Diversity

Kilbryde Hospice supports the principle of equality and diversity

Sponsor Form

Sponsorship form for Kilbryde Hospice

Referral criteria to Kilbryde Hospice

Referral Criteria

Referral of patients to Specialist Palliative Care at Kilbryde Hospice

Patients being referred should be aware of their diagnosis or the life-limiting nature of their condition. They should live in the Cambuslang/Rutherglen, East Kilbride, and Hamilton localities of South Lanarkshire.  

 

Patients

  • Must be 18 years and over and have a progressive or life-limiting condition
  • Been fully assessed by GP, specialist nurse, community nurse or ICST team
  • Have complex needs which are best resolved by the specific skills of a multidisciplinary specialist palliative care team

Referral to Kilbryde Hospice can be made for any individual who has one or more life – limiting conditions if they have;

  • Uncontrolled pain or other symptoms
  • Complex end of life needs
  • Complex physical, psychological, spiritual or family needs that cannot be met by staff in other care settings.

(Scottish Palliative Care Guidelines, 2015)

Their needs must be

  • Physical, psychological, social, or spiritual
  • Related to the patient, carer or family centred.
  • May be intermittent or continuous.

Referral Principles

  • The patient/family member must agree to the referral
  • If at home the GP must agree to the referral
  • If in hospital the referral should be made after approval by the consultant in charge
  • Patients and families can self–refer to some services though we will contact your GP to identify if you will benefit from support from Kilbryde Hospice .

 

If a patient meets this criteria

  • They will be reviewed regularly to ensure they receive care based on their needs and goals
  • This criteria will serve both as entry and exit criteria to Kilbryde Hospice services e.g. as a result of therapeutic intervention, patient’s condition may stabilise. When a patient stabilises and/or their goals are achieved then they will be discharged from our care to the care of their GP and Community Nursing Team.

Referral routes

  • All referrals for Kilbryde Hospice (in-patient unit, out-patient services, and CLAN) should be made via the Specialist Palliative Care Triage and Advice Line on 01698 755 141 Monday to Friday, 9am-5pm.
  • Self-referral for CLAN, Day Services and Carer Support – call our triage line on 01355 202020 Option 3 (Clinical Admin). For patients who self-refer to Kilbryde Hospice, we require to consult with your GP to request a medical summary with which to fully assess you.
  • Outpatient Referrals should be emailed to kilbrydehospice.referrals@lanarkshire.scot.nhs.uk

Discharge Criteria

  • Patient Choice
  • Physical and psychological symptoms adequately managed.
  • Patient moves out of catchment area.

 

Referral of Carers and Relatives to Kilbryde Hospice services

  • Referrals can be made for any carers or relatives of individuals with a life-limiting illness as above. Please call our triage line on 01355 202020 Option 3 (Clinical Admin) to refer.
  • For carers or relatives who self-refer to Kilbryde Hospice, we require to consult with your GP to request a medical summary with which to fully assess you.

Referral form for Day Services, CLAN ( Compassionate Lanarkshire), Carers, Wellbeing and Sunflower service

Used to refer people and family members to community services at Kilbryde Hospice.

CLAN (Compassionate Lanarkshire)

Used to refer people and family members to CLAN ( Compassionate Lanarkshire) services at Kilbryde Hospice.

Gift Aid declaration

An editable Gift Aid Declaration form.

How to raise a concern or complaint about healthcare

We treat complaints seriously and want to ensure that we learn from them, taking action to improve our services.

Volunteer application form

Application form for volunteers.

Sponsor Form

Sponsorship form for Kilbryde Hospice

Kilbryde Hospice relies heavily on your generous donations.

We have many easy ways to donate to our hospice. click the button below and we will guide you along the way.

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