Form Assembly Banner
CESPHN Vax At Home Service

Some people in our community may not be able to access a GP or vaccinationhub to receive a COVID-19 vaccination.The CESPHN Vax at Home Service isONLYfor those people who are housebound and not ableto leave their house to receive aCOVID-19vaccination or booster(their carers will also be able to be vaccinated).

The Vax at Home Service will accept referrals for people 16 years and over. For children 12-16 years with special circumstances and may require further support, referrals will be reviewed on a case by case basis. 

Patient self-referrals willNOTbe accepted. Patients should speak with their GP for a referral to this program if appropriate. Referrals will be accepted from general practitioners and from Local Health Districts.

All referrals MUST be sent through this Vax at Home Service Online Form– for people who are housebound and reside in theSydney Local Health Districtor South Eastern Sydney Local Health District regions. 

For further information on the program, please email vaxathomeservice@cesphn.com.au

 

Winter COVID-19 Dose:


 As per ATAGI recommendations the winter COVID dose is for:

  • Adults aged 65 years and older
  • Residents of aged or disability care facilities
  • People aged 16 years and older with severe immunocompromise (as defined in ATAGI statement on the use of a 3rd primary dose of COVID-19 vaccine in individuals who are severely immuncompromised), and
  • Aboriginal and Torres Strait Islander people aged 50 years and older
If it has been 4 months since the first booster dose and your patient is in one of groups above, they are eligible to have another booster dose as soon as possible before or during winter. COVID-19 winter doses will be available from 4 April 2022.

The additional winter booster dose can be given from 4 months or longer after the person has received their first booster dose, or from 4 months after a confirmed SARS-CoV-2 infection, if infection occurred since the person’s first COVID-19 booster dose.

For further information on Winter COVID Doses please see link to ATAGI statement on recommendations on a winter booster dose of COVID-19 vaccine.

Form Assembly Banner

CESPHN Vax At Home Service Referral Form 

Referred by
Referrer Details 




Patient Information 







Contact Details of Carers or Person Responsible 



Reason For In-Home Vaccination

Which COVID-19 Vaccine is required

Vaccine Status





Winter Booster Dose- COVID-19 Vaccine (As per ATAGI recommendation For Specified populations who are at increased risk of severe disease- These groups are listed on the front page of this online form) 

GP Referral 

Consent 


2022 Influenza Vaccine (As per 2022 influenza vaccines- clinical advise for vaccination providers for eligibility for free influenza vaccines & The National Immunisation Program)



Please see link below for further information on eligibility groups for free influenza vaccine: (Tip: open link in new window - hover over link and right click for instructions)