SIL referral. A place to begin.

Tell us about the participant and the support they need. For Supported Independent Living with Myxa.

CMS preview · Use sample information only · Submissions are stored privately; no email is sent

About this referral

Eight sections. Complete the details you know.

Fields marked * are required.

01

Referrer Details

A little about the person making this referral.

02

Participant Details

Help us get to know the participant.

Interpreter Required
Preferred Communication
Aboriginal and/ or Torres Strait Islander
03

Participant Representative

Details of a representative, carer or nominee.

Guardianship / Administration / Plan Nominee Order in Place?
Relationship
Primary Carer?
Lives with Participant?
Emergency Contact
04

Funding Details

Tell us about the participant’s plan and funding.

SIL Eligibility Confirmed in Plan?

PDF, JPG or PNG. Up to 5 MB per file; 10 MB total.

If SIL eligibility is not confirmed, is a change of circumstances or review in progress?
Plan Management Type
Funding Ratio (Staff:Participant)

Plan Manager Details

05

Disability, Health & Behaviour Summary

Share the information relevant to the participant’s support.

Health Conditions and Behaviours of Concern

Support Intensity

Support intensity refers to the level of support identified in the participant's NDIS plan, not the complexity of the person.

Health Conditions
Behaviours of Concern (if any)
Regulated Restrictive Practices

Are any NDIS Regulated Restrictive Practices currently in place or proposed?

If Yes or Proposed, please indicate type(s):

Existing Documents Available

Behaviour Support Plan (BSP)

PDF, JPG or PNG. Up to 5 MB per file; 10 MB total.

Health / Medical Care Plan

PDF, JPG or PNG. Up to 5 MB per file; 10 MB total.

Occupational Therapy Report

PDF, JPG or PNG. Up to 5 MB per file; 10 MB total.

Speech Pathology Report

PDF, JPG or PNG. Up to 5 MB per file; 10 MB total.

Mealtime Management Plan

PDF, JPG or PNG. Up to 5 MB per file; 10 MB total.

Communication Assessment

PDF, JPG or PNG. Up to 5 MB per file; 10 MB total.

Other reports (e.g. mental health plan)

PDF, JPG or PNG. Up to 5 MB per file; 10 MB total.

06

Support Needs Overview

Describe everyday support, communication and mobility.

Communication Method (select all that apply)

Day Support

Can be alone for short periods (1-2 hours)?
Can be alone for longer periods (3+ hours)?

Night Support

If active night support is needed, select reasons:

Mobility & Equipment

07

Current Situation

Tell us about life and supports right now.

Current Living Arrangement

Current Supports

Day Program / Community Access

Does the participant attend a day program or have established community access?
Is Myxa required to provide Community Participation (CP) supports in addition to Supported Independent Living (SIL)?
08

Matching & Housing Preferences

Help us understand what would make a home the right fit.

Living arrangement requirements

Cultural Requirements

Housing Considerations

Required Accommodation

Location Preferences

Staff Gender Preference

Ready to review?

Use sample information only. Sending saves this referral privately in the preview CMS. No email is sent.

A conversation is a good place to start.

Our team can help you find the right referral pathway.

1300 006 992Get In Touch
Registered NDIS Provider