Ambulatory Diabetes

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Northern Health Ambulatory Diabetes Service


The Northern Health Diabetes Service provides care for people with living with diabetes across our 4 campuses:

The multi-disciplinary Diabetes Service team includes:

  • Endocrinologist
  • Diabetes Nurse Practitioner
  • Diabetes Educator
  • Allied Health (including Dietitian, Podiatrist, Exercise Physiologist)



Referrals are processed to ensure people with diabetes receive the timely care that best meets their needs.

To enable this, Northern Health requests a minimum data set of information from GPs when people with diabetes are referred.  Referrals that are incomplete will not be accepted.

Please include the following:

• Pathology tests (from within the last 3 months)
Including: HbA1c, LFT’s, Fasting Glucose, Total Cholesterol (HDL, LDL) & TRIG, U&Es, Spot Urine ACR, TSH and other relevant results such as  VIT D, B12, lipase & CRP
• Medical History
• Current Medications List
• Contact details including appropriate daytime phone number
• If interpreter required please state language

Note: A referral form is available on Medical Director and Best Practice software. Instructions for downloading the Hume Whittlesea Catchment Diabetes referral template can be found here.
A hard copy is also available.

Pathways of care

The Hume Whittlesea Primary Care Partnership (HWPCP) has developed a pathway of care with support from partner agencies including Northern Health. Each agency now uses a common triage tool, service pathway and an agreed minimum services that each client with diabetes should receive.

The HWPCP Adult Diabetes Service Pathway helps referrers identify the service that best matches the needs of a client with diabetes.   The tool is designed to ensure consistency when triaging and determining complexity.  This assists us in managing referrals more efficiently and allows the redirection of referrals when necessary to partner agencies (with notification and feedback to the referrer).

Our partner agencies include:
- Dianella Community Health
- Plenty Valley Community Health
- Sunbury Community Health

Note: Redirection can only occur between partner agencies listed. GPs will need to refer directly to other agencies not listed.

HWPCP agencies have agreed on the minimum services each patient should receive informed by evidence based practice. The Pathway outlines the services that all patients with diabetes should receive, at different life or disease stages based on the level of complexity of their condition.

Referrers contact

Please fax or mail the referral information to:
Northern Health Ambulatory Care Entry and Triage Service
1231 Plenty Road
Bundoora Vic 3073
Ph: 9495 3443 / 94953109
Fax: 9467 8698
Free call: 1300128539

Please contact our Ambulatory Care Entry and Triage Service if you have any queries about your referral or would like more information on to make a referral.