Apply for Telecare Professionals

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1. Fair Processing Notice
  To find out how we will process and use personal information in connection with this request please see our Privacy Statements.
  This form should only be completed by community based Health or Social Care professionals who are employed by Glasgow City Health and Social Care Partnership (GCHSCP)
  If you are not a Health or Social Care professional employed by GCHSCP and you complete this form, the application for a service will not be progressed. You should complete the standard request for Telecare.
Telecare
1. What type of service are you applying for? Please only choose one
  
  Enhanced Service Request for existing Telecare User
  
  Enhanced Service Request for new Telecare User
3. Why do they need Telecare? Please only choose one
  
  Due to a fall within the last year
  
  For safety and reassurance within the home
  
  To maintain independence
  
  Carer Support
  
  To assist a return home from hospital
4. Please specify planned discharge date
5. To improve the effectiveness and speed of telecare provision for patients coming home from hospital, the standard alarm unit and pendant only will be provided to support safe hospital discharge from Monday 1 July 2024. This will provide guarantees of fast and efficient installation within prescribed discharge timescales. If there are risks that require enhanced telecare please specify them in the Risk Information section. Follow up assessments will be carried out by Care Services to identify further equipment requirements as part of the reablement service.
  Please note any enhanced devices selected will not be provided as this can result in delays to discharge.
6. If this request is for a new telecare user, they will be charged £3.96 per week from the service start date. Invoices will be sent every 4 weeks to the bill payer. Please note we will never contact the bill payer/service user by phone to query your charge or request payment. Who should the invoice be sent to*
  
  Invoices should be sent to the telecare user
  
  Invoices should be sent to someone else
7. Details of Person to invoice
  1. First name
  2. Second name
  3. Phone number
  4. Address
  5. Postcode
  6. Email address
    If you provide an email address then the invoice will be emailed to them
  7. Relationship
Referrers Details
1. First Name*
2. Second Name*
3. Work address*
4. Postcode*
5. Work phone number*
6. Mobile phone number
7. Work email address*
8. What is your relationship to the person who requires the Telecare service?*

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Apply for Telecare Professionals