Health Professional Report for Guardianship Application - NCAT Review

Verified

Added on  2022/11/13

|5
|1072
|364
Report
AI Summary
This assignment presents a Health Professional Report completed by Dr. Tom Cliff, a medical practitioner, regarding Mrs. C, an 84-year-old woman. The report, submitted to the NCAT Guardianship Division, details Mrs. C's medical condition, specifically Vascular Dementia, and its impact on her decision-making capacity. The report indicates Mrs. C's deteriorating condition, including her inability to manage her finances, make informed decisions about her accommodation, and her failure to seek medical attention. Dr. Cliff assesses her cognitive abilities and provides opinions on her capacity to participate in a hearing, suggesting that her attendance may not be in her best interest. The report also includes relevant information about Mrs. C's behavior, observed by her neighbors, which led to the guardianship application. The report concludes with a declaration from Dr. Cliff, attesting to the accuracy of the information and opinions provided. The report is a critical component of the guardianship application process, providing essential medical and cognitive assessments to aid the Tribunal in making decisions about Mrs. C's care and well-being.
Document Page
NCAT Guardianship Division Form | Health Professional Report Form Page | 1
GD-04/2016
Health Professional Report Form
GUARDIANSHIP DIVISION
For more information about completing the Health Professional Report Form please contact NCAT’s Guardianship
Division on (02) 9556 7600 or 1300 006 228.
1. Information about the subject person
title Mr Mrs Miss Ms Other (specify)
given names
family name
date of birth
2. Information about you
title Mr Mrs Miss Ms Dr Prof Other (specify)
given names
family name
professional qualifications
(please outline)
You organisation name and contact details
organisation name
street/PO Box
suburb/town, state, postcode
phone
fax
mobile phone
pager
email
What is your professional relationship to the subject person?
How long have you known the person?
How often do you see the person?
When did you last see the person?
C
C
07/06/1935
Tom Cliff
Cliff
Medical practitioner
Wesley Hospital
45
7634
(03) 6405 3383
+61 8 8748 2312
+61 4 8748 2312
tomcliff@gmail.com
friend
always
24/9/2019
tabler-icon-diamond-filled.svg

Paraphrase This Document

Need a fresh take? Get an instant paraphrase of this document with our AI Paraphraser
Document Page
NCAT Guardianship Division Form | Health Professional Report Form Page | 2
3. Medical information about the subject person
Does the person have a disability? Yes No
Please indicate:
Dementia
Is this disability/condition Mild? Moderate? Severe?
Is this disability/condition Static? Progressing slowly? Progressing rapidly? Improving?
Please state specific diagnosis if known (e.g. Vascular Dementia, Alzheimer’s Disease, Korsakoff’s syndrome, AIDS related
dementia, Pick’s Disease, Lewy body dementia):
How long has the person
had this disability/condition?
Other relevant information
Intellectual Disability
Is this disability/condition Mild? Moderate? Severe?
Is this disability/condition Static? Fluctuating? Improving? Other?
Please state specific diagnosis if known (e.g. Down Syndrome, Autism, Prader Willi Syndrome):
How long has the person
had this disability/condition?
Other relevant information
Brain Injury
Is this disability/condition Mild? Moderate? Severe?
Is this disability/condition Static? Fluctuating? Improving? Deteriorating?
Please state specific diagnosis if known (e.g. CVA, traumatic brain injury, hypoxic brain injury):
How long has the person
had this disability/condition?
Other relevant information
Mental Illness
Is this disability/condition Mild? Moderate? Severe?
Is this disability/condition Static? Fluctuating? Improving? Deteriorating?
Please state specific diagnosis if known (e.g. Schizophrenia, Bi-polar Disorder, Depression):
How long has the person
had this disability/condition?
Other relevant information
Vascular Dementia
8 months
Needs urgent care
Document Page
NCAT Guardianship Division Form | Health Professional Report Form Page | 3
Other disability / medical condition that affects the person’s decision making capacity (please specify)
Is this disability/condition Mild? Moderate? Severe?
Is this disability/condition Static? Fluctuating? Improving? Deteriorating?
How long has the person
had this disability/condition?
Other relevant information
Please state any other
medical conditions that
the person has and any
current medication or
other treatment
Is any of the person’s
medication likely to affect
his or her decision
making capacity?
No Yes, provide details.
Does the person’s
disability affect their
capacity to make
informed decisions about
the following?
Accommodation, care and services? Yes No
If yes, in what ways?
Health and medical care? Yes No
If yes, in what ways?
Financial affairs? Yes No
If yes, in what ways?
Other? Yes No
If yes, please provide details:
Has the person’s
cognitive ability been
assessed?
Yes No
If Yes, please provide the nature and date of the assessment/s and the result/s
(Please provide copies of the above reports/assessments)
He is not in a position to make informed decisions
she has been destroying her compound
She has faiked to see a doctor for the past several months
she cant manage her finances
Document Page
NCAT Guardianship Division Form | Health Professional Report Form Page | 4
Is the person subject to
any orders in other
relevant jurisdictions?
e.g. Protected Estates
Order, Community
Treatment Order, Family
Court, Criminal Matter
Yes No, Don’t know,
If Yes, please provide details including the date on which the order lapses.
Involving the person
Please indicate which of
the following applies:
The person:
speaks English
speaks another language (please specify)
uses sign language / Makaton / language board
(please specify)
uses gestures or other body language to communicate
none of the above
In your opinion, at the
hearing the person will
be:
incapable of making a contribution
capable of making a limited contribution
capable of making a significant contribution
The person has the right to attend and participate in the hearing. The person’s cognitive
impairment or the practical difficulties in bringing them to the hearing are not generally
sufficient reasons to prevent their participation. However, if you are concerned that the
person’s attendance would be detrimental to their health or wellbeing please indicate below
and state the reasons for your opinion:
4. Other relevant information
Please provide any other information which you believe may assist the Tribunal in determining the application
She has been acting strange in the past few months and it will be fair to consider her for the
guardianship application
tabler-icon-diamond-filled.svg

Paraphrase This Document

Need a fresh take? Get an instant paraphrase of this document with our AI Paraphraser
Document Page
NCAT Guardianship Division Form | Health Professional Report Form Page | 5
5. Declaration
I declare that the information provided and opinions expressed in this form are within my area of expertise.
Name
Date
Signature
Please return all pages of the form directly to NCAT’s Guardianship Division or, if appropriate, to the applicant.
Thank you for supporting NCAT to promote the welfare and interests of people with disabilities.
NCAT Guardianship Division
Postal address: PO Box K1026, Haymarket NSW 1240
DX 11539 Sydney Downtown
Street address: Level 6 John Maddison Tower, 86-90 Goulburn Street, Sydney
Telephone: (02) 9556 7600 or 1300 006 228
Email: gd@ncat.nsw.gov.au
Website: www.ncat.nsw.gov.au
Mr Tom Cliff
24/9/2019
chevron_up_icon
1 out of 5
circle_padding
hide_on_mobile
zoom_out_icon
[object Object]