Forms and templates

Registered service providers reporting

Currently the NIISQ Agency is reviewing and improving the reporting requirements for registered providers. Advice will be provided regarding these reporting requirements as soon as they become available.

My Attendant Care and Support Plan

The My Attendant Care and Support (AC&S) Plan assists with managing service delivery expectations between the NIISQ participant and the attendant care and support registered service provider. The My AC&S Plan is developed between the registered service provider and the NIISQ participant using a collaborative process.

The My AC&S Plan must be flexible and responsive to the individual needs of the NIISQ participant and align with their lifestyle requirements. The plan allows registered service providers to include information about all the services the NIISQ participant will receive and what to do if they want to change or cancel a shift. Once the plan is completed, it will be signed by the NIISQ participant and the registered service provider.

All NIISQ participants in receipt of attendant care and support services must have a My AC&S Plan.

Forms for Providers

Service providers can access these forms to provide information to the NIISQ Agency. If you need access to a form that is not on this website, please contact NIISQ Agency on 1300 607 566 or enquiries@niis.qld.gov.au.

Financial

• Vendor Creation or Change Form – Service Providers

  This form is used to set a service provider up as an approved vendor in the NIISQ Agency accounts system.

  Vendor Creation or Change Form – Service Providers (PDF)

Hospital discharge

• Discharge services request form

  The discharge treating team may choose to use this request form to assist with discharge planning for NIISQ participants.

  Discharge services request form (PDF)

Equipment and consumables requests

• Accepted injury-related pharmaceutical or medications form

  This form is to assist doctors to provide the NIISQ Agency with information required to fund accepted injury-related pharmacy or medication needs.

  Accepted injury-related pharmaceutical or medications (PDF)

  Accepted injury-related pharmaceutical or medications (Word Document)

  Additional Accepted injury-related pharmaceutical or medications (PDF)

   

• Equipment Requests

  This form can be used by providers prescribing aids and equipment (assistive technology) for NIISQ participants.

  Equipment Requests (PDF)

• Continence and consumables

  The form enables providers to clinically justify and list the prescription of items required for:
  – Continence
  – Skin integrity and wound management
  – Respiratory and ventilation needs
  – Nutritional needs

  Continence and consumables (.pdf) (uploaded June 2024)

  Continence and consumables (.docx) (updated June 2024)

Assessments and reports

• Care and Needs Scale (CANS) template

  The CANS is a standalone assessment for care needs used for participants with a traumatic brain injury (TBI). It’s a standardised assessment designed by respected neuropsychologist Professor Robyn Tate who has extensive clinical experience in rehabilitation after traumatic brain injury.

  The CANS was created to address a gap in the availability of a psychometrically sound measure that could capture the unique type of support needs experienced by people with TBI. We use a participant’s CANS score to inform the overall needs assessment. Although specifically designed for participants with TBI, we may use a CANS score for other participants—such as those with a spinal cord injury—to help provide a benchmark for care needs.

  Care and Needs Scale (CANS) template (PDF)

• Vocational rehabilitation suitable duties form

  This form is used to provide information when a participant wishes to return to work. This information assists the NIISQ Agency to work with the participant and their employer to develop a return to work plan.

  Vocational rehabilitation suitable duties form (PDF)

• Home modification functional assessment report

  This form is to be completed by a NIISQ approved home modifications adviser (Occupational Therapist) after a home assessment has been performed for a NIISQ participant.

  Approval and discussion with the NIISQ Agency (Participant Care Team) must be obtained prior to completing a home assessment.

  This form is used to identify a person’s specific injury related housing needs and options to meet these needs.

  Please complete the attached report proforma (PDF) for all NIISQ home modification referrals (minor and major).

  Completed reports to be emailed to the participant’s NIISQ Support Planner and cc: modifications@niis.qld.gov.au

• Allied health treatment plan and report

  This form can be used by allied health providers to communicate outcomes of treatment, future treatment goals and clinically justify recommendations.

  Allied health treatment plan and report (docx)