Expression of Interest

This Expression of Interest is to assist My HelpCare Support, in gathering all the information required to adequately assess your referral for Supported Independent Living (SIL), Community Access, Individual Living Options (ILO) and Short Term/ Medium Term Accommodation support (Respite Care). Before completing this document, please ensure that you have the consent to share information if you are completing this expression of interest on someone’s behalf.

You can also ask for and receive support to complete this EOI.

Our intake team will process your expression as quickly as possible and ask for more information where needed.

Feel free to ask us any questions along the way, don’t hesitate to contact our administrator on 02 4071 9000 or via email using our contact form.

EOI

"*" indicates required fields

Participant Details

Participant's Name*

First Last

Preferred Name

NDIS Participant Number*

Plan Expiry Date*

Participant DOB*

Participant Phone

Participant Email

Participant Address

Street Address Address Line 2 City State Postcode

Support Level

Specific Considerations

Comments

How did you hear about MSCS?

Participants Goals

Likes & Hobbies

Disabilities and/or Diagnosis

Current Behaviours Of Concern

Current Participant Support Needs

Days & Times Of Support Needs

Existing, Available Or Potential Informal Supports

Formal Supports In Place

Participant Decision Maker(s)

Please provide Guardian Name, Phone Number, Email Address and Function.

Guardian Name

Phone Number

Email Address

Function

Has the participant had any documented incidents of physical violence or property damage in the last 12 months?*

Yes

No

Are there any regulated restrictive practices in place of the participant? Or are there any restrictions likely to need to be implemented?*

Yes

No

Supporting Documents

Copies of documents attached

Details Of Person Completing This Form

Referrer Name

First Last

Referrer Phone*

Referrer Email*

Referrer Address*

Street Address Address Line 2 City State Postcode

Alternate Contact Name*

Alternate Contact Phone*

Consent*

I have the consent to share the participants information.

My HelpCare support Internal Approval

Service has capacity to approve application

Yes

No

Manager Name

Date

Signature

CAPTCHA

Important Information

What happens next?

MCHS staff will be in touch to confirm your expression of interest has been received and advise of the details for the next step;
MCHS will process your EOI and assess its capacity to provide the supports you have requested and will let you know the outcome in writing;
Our intake team may ask you to provide additional information or take further action to support your expression of interest.

If we confirm that we can likely meet your support request, we will seek to make further arrangements with you and your support network.

These arrangements may include:

Meeting in person and discussing your request in more detail as pertaining to person centred supports;
Gaining your consent to speak further with people involved in your care;
Inviting you to come and view a home or location;
Introducing you to more of our team and any other people who you might be around if you start receiving supports from us; and
Working with you to develop a transition plan or possible timelines to start receiving support.

When can I come and stay or move in?

We will need to work together before you can stay short term or move in.

We will work together to:

Complete the Expression of Interest, with any available documents attached;

Make sure everyone approves, and gives consent (including guardians if appointed);
Talk about the Service Agreement making sure we agree on details, rights and responsibilities;
Receive formal approval (in writing) from the National Disability Insurance Agency (NDIA) as well as any other funding bodies involved in your care (such as Department of Community Services and icare); and
Sign and complete the Service Agreement, arranging the date for your first stay in the processes.