HEN Register

1. Please complete only one registration form for each new and existing patient recommended for home enteral nutrition (adult and paediatric). All HEN patients should be included regardless of where the formula is purchased. You do not need to fill out a new form every time you review a patient unless details change, eg change from oral nutrition support to PEG. The form should be filled on/near discharge.

2. Please include:
(i). All patients receiving nutrition support via tube and
(ii). Only patients who you expect to require oral nutrition support for at least 1 month or currently receiving oral nutrition support for at least one month.

3. Include patients discharged to nursing homes and hostels. If you do not provide services to patients in nursing homes and extended care facilities please complete a discharge form at time of registration.

4. For text boxes, please print clearly in capital letters.

5. For tick box fields, please mark one box only

6. If you cannot fill in all the fields, leave the field blank or write in your response in the boxes provided. Please provide an estimate if the date of commencing HEN, weight and height are not known.

7. Please fax completed forms to 02 9887 5430 (no cover page is required)

1. Please complete the HEN Discharge Form if a patient no longer requires HEN.
For example:

• Return to oral intake (no longer needing HEN)
• Deceased
• Requires parental nutrition
• Transferred care nursing home
• Transferred care hostel
• Transferred care group home
• Transferred care other NSW health care site
• Relocated outside NSW
• Other

2. Please fax completed forms to 02 9887 5430 (no cover page is required)

Please contact the HEN Network Manager if you have any queries
i. Telephone: (02) 8877 5165
ii. Email: gpang@nsccahs.health.nsw.gov.au