Chronic Care Coordinator
- Comprehensive assessment of care needs.
- Multi-disciplinary care plan coordination.
- Health and community care providers.
- Education and self-management of the chronic illness.
- Initiation and coordination of services as required.
Service exclusions apply for this service.
- Documented diagnosis of cardiac disease or COPD
- Likely compliance to a developed care plan
- Reside in the Coffs Harbour LGA
- Unplanned readmission within 28 days x 1 or more within a 12 month period
- ED presentations ≥ five times within a 12 month period
- Three or more admissions in a 12 month period related to cardiac disease or COPD.
Self or family/carer can refer to this service
345 Pacific Highway
Coffs Harbour NSW 2450
Referrals via Intake Service.