NDIS Concurrent Supports Template

For Hospitals & Local Health Districts (LHD) to request consideration of concurrent supports for a NDIS Participant in hospital. In line with NDIS Operational Guideline — Disability-related health supports | NDIS - “What if you go into hospital?”. As well as The Applied Principles and Tables of Support to Determine the Responsibilities of the NDIS and other Service Systems | Department of Social Services

Complete all fields below and submit to NDIA Health Liaison Officer (HLO).

1. Staff Details (Health)


Health Requester Contact Details (Title, Name, Email, phone number, Hospital / Local Health District)
Executive Sponsor / Lead notified (Title, Name, Email, Phone)
Date of request


Name
Date of Birth
NDIS Number
Address
Disability
Hospital:
Estimated Date Discharge (EDD) (when medically ready for discharge)
Any days exceeding EDD

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FOI 24/25-1158 Disclosure Log

Request for Concurrent Supports For Internal and External Use


Describe the complex care needs of the participant
Describe the reasons why the participant requires concurrent supports for complex communication needs or challenging behaviours
Outline Reasonable Adjustments implemented by the Hospital to address issues identified above
Concurrent Supports requested (hours, ratio and time of day)
Supporting Evidence

Version	Amended by	Brief Description of Change	Status	Date
0.1	P70086	Initial versions collated for accessibility and alignment to NDIS Operational Guideline	DRAFT	08-01-2025
1.0	KR0016	Approved by Director Hospital Interface	Final	29-01-2025

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