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HHI Referrals

HHI Referrals

Referral Information

MM slash DD slash YYYY

Referral Details

Residency Status?(Required)
Low income family?(Required)
Verbal consent for HHI services granted?(Required)
Verbal consent granted to share information with HHI provider?(Required)
DD slash MM slash YYYY
Address(Required)
*at least one member of the household must be a New Zealand citizen or permanent resident

Eligibility Criteria:

Group A

Children 0 – 5 that have been hospitalised with one of the following conditions:

  • Bronchiolitis
  • Pneumonia
  • Bronchiectasis
  • Tuberculosis
  • Lower Respiratory Tract
  • Infection Asthma
  • Meningitis
  • Meningococcal Disease
  • GAS Sepsis
  • Post Strep GN
  • Acute Rheumatic Fever
  • *Skin Infections

Group B

Children 0 – 5 who have two of the following risk factors:

  • Oranga Tamariki finding of abuse or neglect
  • Caregiver with a corrections history
  • Mother with no formal qualifications
  • Long-term benefit receipt

Group A

Children 0 – 5 that have been hospitalised with one of the following conditions:

  • Bronchiolitis
  • Pneumonia
  • Bronchiectasis
  • Tuberculosis
  • Lower Respiratory Tract
  • Infection Asthma
  • Meningitis
  • Meningococcal Disease
  • GAS Sepsis
  • Post Strep GN
  • Acute Rheumatic Fever
  • *Skin Infections

Group B

Children 0 – 5 who have two of the following risk factors:

  • Oranga Tamariki finding of abuse or neglect
  • Caregiver with a corrections history
  • Mother with no formal qualifications
  • Long-term benefit receipt

Group C

Pregnant people/ women and new Oranga Tamariki finding born babies

Group D

Rheumatic Fever: 0-19 years with 3 or more household episodes of Group A Streptococcus (GAS) pharyngitis OR A member of the household with Rheumatic Fever and receives Prophylactic medication OR aged 0-19 years with Rheumatic Fever

Group C

Pregnant people/ women and new Oranga Tamariki finding born babies

Group D

Rheumatic Fever: 0-19 years with 3 or more household episodes of Group A Streptococcus (GAS) pharyngitis OR A member of the household with Rheumatic Fever and receives Prophylactic medication OR aged 0-19 years with Rheumatic Fever

**skin infections include: Scabies/Impetigo/Cellulitis/Infected eczema
Eligible Child/Children's details:
Name
NHI
Comments
 
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Family Income Eligibility

Family Size

Annual Family Income

Family of 2

$57,317

Family of 3

$70,551

Family of 4

$81,393

Family of 5

$92,042

Family of 6

$103,764

*For families of more than 6, the limit goes up another $10,517 for each extra person

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