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Emergency Accommodation Service FY23/24

This is a preview of the Emergency Accommodation Service Grant form. When you’re ready to apply, click Fill Out Now to begin.

Referral from:

* indicates a required field.

Family requiring accommodation assistance must reside a min of 30kms from GCUH.
The patient receiving care must be an emergency admission or transfer. Assistance requests for Follow up elective surgery or treatment will not be considered unless the patient is re admitted into a critical care unit.
Case for support notes must be complete to assess the referral
Accommodation assistance is not covered once the patient moves to the ward
Requests for extensions must be made weekly via email to the Foundation
Decisions to supply accommodation is subject to availability and at the sole discretion of the Gold Coast Hospital Foundation
Standard accommodation provided is a single room with 1 Double bed - multiple room accommodation requests will require a higher family contribution (negotiable with GCHF)
Accommodation is provided and reviewed on a week by week basis with a maximum of 4 weeks accommodation provided.
All incidentals booked to the Accommodation are the responsibility of the person/s staying in the room

To be completed by an authorised Nurse, Doctor or Social Worker .

Referring Social Worker *

First name	Last name

Position *

Best Contact Number *

Must be an Australian phone number.

Mobile Number

Must be an Australian phone number.

Email *

Must be an email address.

Referring Unit

Referring Medical Specialist *

First name	Last name

Position *

Best Contact Number *

Must be an Australian phone number.

Email *

Must be an email address.