The Dispensation request form (Word, 68 KB) is for rest home providers who are seeking a dispensation to offer hospital level care for one named resident for up to three months.
A dispensation enables a rest home resident who has been assessed as needing hospital level care to remain in their current environment for a short period of time. For instance, while:
- hospital level care is found for the resident in another part of the facility or in a different facility
- the resident receives end of life care.
The information provided on this form will be assessed on whether:
- the arrangements are safe
- the resident's identified hospital level care needs can be met
- there will be limited impact on other residents.
An extension beyond three months is rarely approved.
When you have completed this form, email it to your district health board (DHB) Portfolio Manager and obtain their support for this dispensation.
Once you have support from your DHB send the form and evidence of the DHB’s support to HealthCERT at firstname.lastname@example.org
If you have any questions, please contact HealthCERT on 0800 113 813.