Tākiri Mai Te Ata Whānau Ora Collective Referral Form

First name
Whanau name
Date of birth
Age
Ethnicity
Gender male female
IWI
NHI#
Number of tamariki/mokopuna
Age range 0-4 years
5-10 years
11-17 years
Address
Home phone
Work phone
Mobile phone
Email
Preferred contact number
Current medical centre
Referral date:
Referrer name
Organisation
Referrer Contact Details
Fax number
Has whanau been informed? yes no

COLLECTIVE SERVICES

Naku Enei Tamariki (Maori Section) (NET)

Tamariki Details If Applicable
Pepe Due Date
Required for Te Awhi o Te Rito Hapū Wānanga
Or Pepe Name
LMC/Midwife Name
Required for Te Awhi o Te Rito Hapū Wānanga
Baby's date of birth
Baby's NHI#
Services required
Awhi Mai Awhi Atu Playgroup 0 - 6 Years (Wainuiomata only)
Early Intervention - Nurture,Enjoy,Teach 0 - 5 Years
Family Start for vulnerable whānau 0 - 12 months
Haakuitanga Haakorotanga - Māori Parenting Programme
Incredible Years Parenting Program 3 - 8 Years
Poipoia Te Mokopuna - Te Ao Maori Programme 0 - 3 Years
Puawai Māmā Support Group 0 - 5 Years
Te Awhi Rito Hapū Wānanga

Tu Kotahi Maori Asthma Trust

Services required
Asthma
COPD
Bronchiolitis
Well Homes
Other Respiratory

Mana Wahine

Services required Cervical Screening
Breast Screening
Te Mauri- Whakamana Māori Whānau with Cancer

Kokiri Marae Keriana Olsen Trust

 - Whānau Ora Social Services
- Tihei Rangatahi - Programmes for Wainuiomata Rangatahi
- Kāti te Tūkino - Supporting Violence Free Whānau
- Tama Tū Tama Ora - Mens Non Violence Group
- Te Ao Marama - Wahine Anger Management Group
- Kaumatua Support Services
- Whanau Ora Hapū Māmā
- Sexual Health Clinics
- Outreach Diabetes Service
- Outreach Immunisation Service
- Child Car Seat Rental Scheme
- Hā Whakatā
- He Waka Eke Noa - Rangatahi Māori aged 17-24 years old, Living in the Hutt Valley & WOA, Not in Employment, Education or Training (NEET), Support for Rangatahi to become "Work Ready"

Moe Ora Mo Ngā Pēpē

Wahakura/Pēpē Pod Criteria Smoke Exposed to baby
Safety concerns identified by clinician
Māori/Pacific people prioritised

Kokiri Marae Maori Women's Refuge

Servies required
Whakaoho Wairua Living without Violence Programme
24 Hour Crisis Line - 04 566 5025
Safe House Support

Tākiri Mai te Ata Services

Services required
Whānau Ora Navigator Services
Regional Stop Smoking Services
Homelessness Prevention (Early Intervention Service)
Budgeting
Mental Health
Te Kete Aronui - Therapeutic Music Prog for Rangatahi

Whai Oranga O Te Iwi Health Centre

Services required Comprehensive Primary Health Services
Community Dental Service for Adults
& FREE Adolescent Dental Services for aged 13 - 18 years.

Wainuiomata Marae - Ph: 5648395

Services required
WOA Social Service Support
A wonderful venue and facilities
Ora Tika- Rongoa Maori

Reason for Referral

Reason
How soon is intervention required?
First name
Whanau name
Date of birth
Age
Ethnicity
Gender
male female
IWI
NHI#
Number of tamariki/mokopuna
Age range
0-4 years
5-10 years
11-17 years
Address
Home phone
Work phone
Mobile phone
Email
Preferred contact number
Current medical centre
Referral date:
Referrer name
Organisation
Referrer Contact Details
Fax number
Has whanau been informed?
yes no

COLLECTIVE SERVICES

Naku Enei Tamariki (Maori Section) (NET)

Tamariki Details If Applicable
Pepe Due Date
Required for Te Awhi o Te Rito Hapū Wānanga
Or Pepe Name
LMC/Midwife Name
Required for Te Awhi o Te Rito Hapū Wānanga
Baby's date of birth
Baby's NHI#
Services required
Awhi Mai Awhi Atu Playgroup 0 - 6 Years (Wainuiomata only)
Early Intervention - Nurture,Enjoy,Teach 0 - 5 Years
Family Start for vulnerable whānau 0 - 12 months
Haakuitanga Haakorotanga - Māori Parenting Programme
Incredible Years Parenting Program 3 - 8 Years
Poipoia Te Mokopuna - Te Ao Maori Programme 0 - 3 Years
Puawai Māmā Support Group 0 - 5 Years
Te Awhi Rito Hapū Wānanga

Tu Kotahi Maori Asthma Trust

Services required
Asthma
COPD
Bronchiolitis
Well Homes
Other Respiratory

Mana Wahine

Services required
Cervical Screening
Breast Screening
Te Mauri- Whakamana Māori Whānau with Cancer

Kokiri Marae Keriana Olsen Trust

- Whānau Ora Social Services
- Tihei Rangatahi - Programmes for Wainuiomata Rangatahi
- Kāti te Tūkino - Supporting Violence Free Whānau
- Tama Tū Tama Ora - Mens Non Violence Group
- Te Ao Marama - Wahine Anger Management Group
- Kaumatua Support Services
- Whanau Ora Hapū Māmā
- Sexual Health Clinics
- Outreach Diabetes Service
- Outreach Immunisation Service
- Child Car Seat Rental Scheme
- Hā Whakatā
- He Waka Eke Noa - Rangatahi Māori aged 17-24 years old, Living in the Hutt Valley & WOA, Not in Employment, Education or Training (NEET), Support for Rangatahi to become "Work Ready"

Moe Ora Mo Ngā Pēpē

Wahakura/Pēpē Pod Criteria
Smoke Exposed to baby
Safety concerns identified by clinician
Māori/Pacific people prioritised

Kokiri Marae Maori Women's Refuge

Servies required
Whakaoho Wairua Living without Violence Programme
24 Hour Crisis Line - 04 566 5025
Safe House Support

Tākiri Mai te Ata Services

Services required
Whānau Ora Navigator Services
Regional Stop Smoking Services
Homelessness Prevention (Early Intervention Service)
Budgeting
Mental Health
Te Kete Aronui - Therapeutic Music Prog for Rangatahi

Whai Oranga O Te Iwi Health Centre

Services required
Comprehensive Primary Health Services
Community Dental Service for Adults
& FREE Adolescent Dental Services for aged 13 - 18 years.

Wainuiomata Marae - Ph: 5648395

Services required
WOA Social Service Support
A wonderful venue and facilities
Ora Tika- Rongoa Maori

Reason for Referral

Reason
How soon is intervention required?

Phone 0508 KOKIRI - [email protected]

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