Service Site Inclusion Criteria Exclusion Criteria External Referral Accepted How to Refer
HARP – Complex BECC/BHS Loss of weight/poor appetite, chronic disease (excluding renal), gastrointestinal disorders and neurological disorders effecting nutrition General healthy eating advice, food allergies and intolerances, eating disorders No Referrals from HARP services other than HARP diabetes to be triaged by site dietitians to SACS/CHSP/ HACC PYP or NDIS services as appropriate. Internal referrals from HARP complex needs team only
HARP – Diabetes BECC/BHS Urgent Pathway -Recent DKA, HHS, T1DM and LADA insulin commencement stabilisation, recurrent hypoglycaemia, active foot ulcer or wound. Intermediate pathway; HbA1c >8.5%, BGL >22 mmol/L, Triglycerides >11.2 mmol/L, eGFR <45 ml/min/ 1.73m2, T2DM requiring insulin or GLP – 1 initiation or titration, newly Dx T2DM not stabilised within 3/12, On corticosteroids regardless of HbA1c pre diabetes, New Dx T2DM, HbA1c <8.5% , egfr > 45, no active foot pathology or Hx of complications, not requiring insulin initiation or titration yes Written referrals sent to ACETS  with recent pathology
HARP – FPU TNH Must be attending FPU to see podiatrist/CNC. Referral criteria: HbA1C >7% / MST ≥ 2 referral / stage to or greater PI / weight management. Being seen by another DT (in the community or within NH e.g. renal). No  
NDIS BECC Adults between 18-65 years of age with a disability. Dietetics/allied health hours need to be specified on the NDIS plan for  assessment and intervention Patients presenting with any of the following will not be accepted through NH NDIS dietetics: Intellectual disability, eating disorders, food allergies , paediatrics , no hours for dietetics on NDIS plan Yes Written referrals sent to ACETS
CHSP BECC Adults over 65 years of age. Resides in the NEMA catchment. Requires intervention to support living in the community. Patients approved and awaiting pick up with Level 3/4 Home Care Packages or EACH packages are able to receive services Adults <65 years of age. Adults from High Level Care or those in possession of Level 3/4 Home Care or EACH packages  are not eligible for our service and will need to be redirected to a Private Dietetics service Yes My Aged Care Referral via MAC website
HACC PYP BECC Adults between 18-65 years of age without disability, or awaiting transition to NDIS. Adults >65 years of age. Yes Written referrals sent to ACETS
GEM@Home BECC Patient must be a current home-based Northern Health GEM inpatient Patients not currently a home-based GEM inpatient No Referrals generated by case coordinator or other medical or allied health staff via Healthpower
Cardiac Rehab Group TNH/CHS/BECC Patients participating in heart failure or cardiac rehabilitation programs at Northern Health (TNH, BECC or CHS) Patients not participating in heart failure or cardiac rehabilitation programs at Northern Health (TNH, BECC or CHS) No  
Endocrinology/Diabetes TNH     No  
Antenatal TNH/BHS/CHS     No  
Paediatric TNH/CHS Failure to thrive, multiple nutrient deficiencies,

allergies and nutritional concerns related to a medical condition and excess weight/growth <2yrs age

General nutrition or healthy eating advice No Must come from TNH staff + have current TNH Paediatrician input
Paediatric HELP TNH Healthy Eating and Lifestyle Program

for children aged 2-18 years requiring paediatrician and dietitian input for weight management (overweight/obesity)

<2 years of age

>18 years of age

Yes Written referrals sent to ACETS
Paediatric Feeding Clinic TNH/CHS Complex feeding difficulties or oral aversions

for infants and toddlers

Home Enteral/PEG Feeding

Requirement for modified EBM/specialised/fortified infant formula

Persistent severe food refusal/selective eating resulting in restriction of one or more food groups and/or affecting growth

Fussy Eating Yes External referrers to call Paediatric Dietitians on

8405 8666 to discuss suitability prior to making referral

OAKS TNH >65yo + BMI>27kg/m2

<65yo + BMI>25kg/m2

  No  
Renal TNH/BH/CHS Adults (18 years and over) with Chronic Kidney Disease (including those on haemodialysis)   No  
Gastro Screening Clinic TNH/BHS Patients over 18 years old with IBS – type symptoms (altered bowel habits, bloating, distension), diverticulosis or possible coeliac disease associated gastrointestinal symptoms Patients under 18 years old, Category 1 gastroenterology patients, Gastroenterology inpatients, Patients presenting with: Acute abdomen or severe abdominal pain, Inflammatory Bowel Disease (IBD) patients with active disease, For colonoscopy, Liver conditions, Upper gastrointestinal tract presentations No Referrals not accepted. Appropriate patients are triaged to this clinic via the Gastroenterology OP WL
IBD Diet Clinic TNH NH patient diagnosed with Inflammatory Bowel Disease (Crohn’s disease, Ulcerative colitis, Microscopic colitis – collagenous and lymphocytic).   No Internal referrals only. Referral via ACETS with completion of Allied Health referral form. Referral to state diagnosis of IBD and clinic code NIBDDIET
PEG Gastroenterology TNH Adults (≥18 years).

Patients with a gastrostomy feeding tube insitu requiring change / removal of tube, troubleshooting of tube, or gastrostomy stoma management.

Patients for consideration of insertion of new gastrostomy feeding tube requiring education.

Paediatrics/Children (<18 years).

Patients without feeding tube insitu (excluding those who require education prior to insertion of gastrostomy tube)

Patients with other feeding tubes (eg. Jejunostomy, Nasogastric)              Patients requiring general enteral feeding or nutrition management

Yes GP referral required for all patients to attend clinic. Must be referred/addressed to both PEG Credentialed Dietitian and Gastroenterologist. Referrers to call PEG Credentialed Dietitian on 8405 8666 to discuss suitability prior to making referral.
Surg/Oncology TNH Rapid weight loss due to illness or treatment, Significant underweight or low BMI <18kg/m2 or weight loss of 5-10% in preceding 3-6months, Recent Surgery/Oncology treatment General healthy eating, Weight reduction, High Cholesterol/Cardiovascular disease, high blood pressure, nutrient deficiencies, fluid management, Diabetes, allergies, eating disorders, all GP/external provider referrals No  
SACS- Chronic Wound Service BECC/BH/CHS As per CWS directory – ‘A persistent area of broken skin, or a wound with delayed healing that has been present for more than 28 days.’ As per CWS directory – ‘Recent surgical wound less than 1 month duration. ‘ Yes (to service) All new patients admitted to CWS screened by CWS Dietitian.
SACS – CTS BECC/BH/CHS Recent (<8 weeks) surgery or hospitalisation with related rehabilitation goals. Weight management, loss of weight/poor appetite, chronic disease (excluding renal), gastrointestinal disorders and neurological disorders effecting nutrition. Food intolerance referrals will only be accepted at the BECC site if referrals are from NH continence clinic. Patients from CRU’s are eligible for SACS services only following an in-patient hospital stay where there are specific, new needs. Dietetics only referrals for SACS will only be accepted where the referral is for malnutrition and the patient has been referred directly following an in-patient hospital stay. Referrals for SACS must otherwise be multidisciplinary. Adults from High Level Care or those in possession of Level 3/4 Home Care or EACH packages  are not eligible for our service and will need to be redirected to a Private Dietetics service. Adults requiring long term intervention/monitoring to be redirected to HACC PYP/ NDIS or CHSP services Yes (post recent hospital admission from Northern or other hospitals) Written referrals sent to ACETS
SACS – Adult Rehabilitation CHS Recent (<8 weeks) surgery or hospitalisation with related rehabilitation goals. Weight management, loss of weight/poor appetite, chronic disease (excluding renal), gastrointestinal disorders and neurological disorders effecting nutrition.** Patients from CRU’s are eligible for SACS services only following an in-patient hospital stay where there are specific, new needs. Dietetics only referrals for SACS will only be accepted where the referral is for malnutrition and the patient has been referred directly following an in-patient hospital stay. Referrals for SACS must otherwise be multidisciplinary. Adults from High Level Care or those in possession of Level 3/4 Home Care or EACH packages  are not eligible for our service and will need to be redirected to a Private Dietetics service. Adults requiring long term intervention/monitoring to be redirected to HACC PYP/ NDIS or CHSP services Yes (post recent hospital admission from Northern or other hospitals) Written referrals sent to ACETS
SACS- Diabetes CHS Urgent Pathway -Recent DKA, HHS, T1DM and LADA insulin commencement stabilisation, recurrent Hypoglycaemia, Active foot ulcer or wound . Intermediate pathway, -HbA1c >8.5%, BGL >22 mmol/L, Triglycerides >11.2 mmol/L, eGFR <45 ml/min/ 1.73m2, T2DM requiring insulin or GLP – 1 initiation or titration, newly Dx T2DM not stabilised within 3/12, On corticosteroids regardless of HbA1c Pre diabetes, New Dx T2DM, HbA1c <8.5% , egfr > 45, no active foot pathology or Hx of complications, not requiring insulin initiation or titration Yes Internal referrals via SACS team. External referrals sent to ACETS with recent pathology
SACS- Prime CHS All patients referred into the PRIME clinic, including patients requiring weight loss education (e.g. healthy eating education, VLED education, improving glycaemic control & correcting any vitamin/ mineral deficiencies. Patients not referred into PRIME clinic No Internal referrals sent to ACETS
VACS – Adult CHS/BH Referrals accepted post inpatient stay at TNH/ BECC/BHS and from Northern Health medical, nursing and allied health clinicians. Clients must be >18years old Adults who are currently accessing other Dietetic services (e.g. Home-based TCP, GEM@Home, HARP, Private, SACS). Adults currently receiving funding via an EACH package: Tier 3 & 4. Adults in high level care in Residential aged care facilities/ Nursing Homes, No Internal referrals from NH allied health or medical staff via ACETS