Resource Kit for Caregiving & Community Mental Health Partners - AIC

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Resource Kit for Caregiving & Community Mental Health Partners - AIC
Resource Kit for
         Caregiving &
     Community Mental Health
           Partners

                                                  Page 1 of 81
(Service Providers)
For information, please write in to ccmh@aic.sg
Updated as at June 2021
Resource Kit for Caregiving & Community Mental Health Partners - AIC
Contents
Introduction..................................................................................................................................... 4
About the Community Mental Health Masterplan & Programmes ............................................... 4

CREST (Community Resource, Engagement & Support Team) .................................................. 9
CREST-Youth (Community Resource, Engagement and Support Team for Youth) ................ 12
COMIT (Community Intervention Team) ...................................................................................... 13
Youth Integrated Team ................................................................................................................. 16
Aftercare ........................................................................................................................................ 17
ASCAT (Assessment & Shared Care Team) ............................................................................... 18
Mental Health in Primary Care ..................................................................................................... 20
   List of GPs under General Practitioners Partners by Regions .............................................. 22

Dementia-Friendly Singapore ...................................................................................................... 35
Night Respite (put on hold till further notice) ............................................................................. 40
Go Respite..................................................................................................................................... 41
Post-Diagnostic Support – Dementia .......................................................................................... 45
Other Community Programmes/Services ................................................................................... 46
   Financial Subsidies for Mental Health Services ...................................................................... 46

   Employment Support ................................................................................................................ 46

   Mental Health Facilities ............................................................................................................. 49

      Psychiatric Day Care Centres ............................................................................................................... 49
      Dementia Day Care Centres ................................................................................................................. 50
      Psychiatric Rehabilitation Homes ......................................................................................................... 52
      Psychiatric Nursing Homes ................................................................................................................... 53
      Psychiatric Sheltered Homes ................................................................................................................ 53
   Private Ambulance Services .................................................................................................... 54

   Decluttering Services & Assistance Funds ............................................................................. 56

   Social Service Agencies ........................................................................................................... 61

      Social Service Offices ............................................................................................................................ 61
      Family Service Centres .......................................................................................................................... 62
      Single-parent Family Service Centres ................................................................................................. 65

                                                                                                                                            Page 2 of 81
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Family Violence Specialist ..................................................................................................................... 65
      Community Befriending Programme.................................................................................................... 65
Resources ..................................................................................................................................... 70
   Referral to careinmind@aic.sg ................................................................................................. 70

   List of Publicity Collaterals ...................................................................................................... 73

   List of Videos............................................................................................................................. 78

e-Learning Modules ...................................................................................................................... 80

                                                                                                                                         Page 3 of 81
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Resource Kit for Caregiving & Community Mental Health Partners - AIC
Introduction
This resource kit aims to provide information and resources to empower you in supporting your clients
and caregivers in the community. If you need any clarification, please contact your respective
Programme Manager or email ccmh@aic.sg.

About the Community Mental Health Masterplan & Programmes
Since 2012, the Agency for Integrated Care (AIC) was appointed by the Ministry of Health to develop
the Community Mental Health (CMH) Masterplan. The plan focuses on working closely with the health,
social and community care partners to build an integrated mental health network to better support for
persons at risk/with mental health issues including dementia and their caregivers in the community.

                                                                                          Page 4 of 81
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Overview of the Mental Health Support & Services

 Programme               What it does                                           Who will benefit

 Community                  Raise public awareness of mental health            General public benefits
 Resource,                   through outreach events to residents and           from basic
 Engagement and              caregivers                                         understanding mental
 Support Team               Provide coordinated person-centric care            wellness and mental
 (CREST)                     (social and health), information and support for   health
 aka Community               clients and caregivers through providing basic
 Outreach Teams              emotional support, follow up and service           Clients who are at risk
                             linkage                                            and unaware of social
                            Monitoring clients with long term needs            and mental health
                            Network, engage community partners and             support available; and
                             coordinate mental health trainings and             their caregivers
                             education

                         Note – For Partners who focus on those who are
                         well but at-risk, empty nesters, their engagement
                         approach may differ and include club
                         membership, preventive activities

                         CREST - Eldersitter (ES) Programme                     Person with/at risk of
                         CREST services (as above) with additional              dementia/ MCI; and
                         services such as                                       can benefit from
                          Engage persons with at risk / dementia in            meaningful activities
                            meaningful activities to maintain their cognitive   engagement
                            functions
                          Provide respite care services for caregivers

                         CREST - Caregivers (CG) Programme                      Caregivers who have
                          Increase public awareness of caregiver               or are at risk of
                           concerns and the support required for their          developing depression,
                           mental wellness                                      anxiety and burn-out
                                                                                due to their caregiving
                          Promote the identification of caregiver needs
                                                                                role.
                           and link up to support services in the
                           community
                          Provide basic emotional support, mental
                           wellbeing and support to caregivers
                          Empower caregivers to be able to support
                           other caregivers

                         Community Resource, Engagement and
                                                                                CREST-Youth’s target
                         Support Team for Youth (CREST-Youth)
                                                                                population is in the 1)
                          Increase public awareness of mental health by
                                                                                general youth
                            organising outreach events for the youth
                                                                                population 2) youths
                                                                                              Page 5 of 81
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Programme               What it does                                           Who will benefit

                             population, as well as those in their circles of   at-risk of developing
                             support.                                           mental health issues
                            Promote the recognition of early signs and         and 3) caregivers of
                             symptoms of mental health conditions.              youths with mental
                            Provide coordinated person-centric care            health issues.
                             (social and health), information and support for
                             youths and their caregivers through providing      Youth is defined here
                             basic emotional support, follow up and service     as 12-25-year-old, not
                             linkage.                                           yet in the workforce.
                            Network, engage community partners and
                             coordinate mental health training and
                             education.
                            Involve parents and peers in the recovery
                             journey of youths.
 Community                  Perform needs assessments of clients and           Persons at risk of,
 Intervention Team           caregivers                                         suspected of, or
 (COMIT)                    Develop individualised intervention plans,         diagnosed with mental
                             case management and monitoring of clients in       health conditions, and
                             the community, in close collaborations with GP     their caregivers
                             or hospital for further assessment and
                             treatment/interventions
                            Counselling and other psycho-social therapy
                             for clients and caregivers
                            Home visits for assessment and close follow
                             ups on clients and caregivers for effective
                             coping
                            Provide case management, care coordination
                             and service linkages for clients to appropriate
                             services based on their needs
                            Training and outreach e.g. to improve
                             awareness, understanding of mental disorders
                             for general public

 Youth Integrated           Increase awareness of mental health through        Youths at-risk of,
 Team                        targeted outreach to youth at higher risk for      showing signs and
 (YIT)                       mental health conditions, their families and       symptoms of, or
                             their support systems                              diagnosed with mental
                            Promote the recognition of early signs and         health conditions, and
                             symptoms of mental health conditions.              their caregivers.
                            Provide coordinated person-centric care            Youth is defined here
                             (social and health), intervention and support      as 12-25-year-old, not
                             for youths and their caregivers through            yet in the workforce.
                             providing assessments, therapeutic
                             interventions and case management.

                                                                                              Page 6 of 81
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Programme               What it does                                           Who will benefit

                            Engaging community and healthcare partners
                             to build a supportive environment for youths
                             with mental health issues through active
                             collaborations and co-management of cases.
                            Facilitate the formation of supportive
                             relationships with families and peers in the
                             recovery journey of youths.
 Aftercare                  Provide transitional care through case             Persons with mild to
                             management to optimise functioning including       moderate mental
                             sustaining the psychological well-being of         health conditions
                             clients with complex needs
                            Integrate clients’ health and social needs
                                                                                Complex needs (two or
                             through collaborative partnership by providing
                             holistic needs assessment and care                 more needs) and/or
                            Aims to adopt a population approach through        those with frequent
                             a shared structural framework to identify and      relapse episodes, non-
                             monitor clients, escalation process and            adherence to
                             protocol                                           treatment and
                                  o Co-owned by partners                        appointment
                            Process improvement by tailoring to the
                             targeted population and ground needs
 Assessment &                Provide clinical care, assessment, diagnosis,     For patients with
 Shared Care                  stabilization and treatment for clients with      moderate to severe
 Team (ASCAT)                 mental health conditions and dementia             mental health
                             Build capability of providers including primary   conditions such as
                              care physicians for example, GPs and              depression, dementia,
                              community partners to provide quality mental      anxiety etc.
                              health care through training and professional     The mental health
                              support                                           component will include
                             Develop community support initiatives and         mental health
                              provide clinical leadership in the development    assessment,
                              of integrated community mental health             medication,
                              network                                           psychotherapy and
                                                                                any other intervention
                                                                                where appropriate as
                                                                                provided by multi-
                                                                                disciplinary team.
 Mental Health in           Provides consultation and diagnosis,               Clients with mild to
 Primary Care                pharmacotherapy, therapy or counselling to         moderate MH
 (comprising                 support the client to cope and improve daily       conditions and
 Polyclinics,                functioning                                        dementia who need
 General                     Provides education and resources for               intervention and
 Practitioner (GP)           caregivers on how to better engage and             support
 clinic, Polyclinic &        support their loved ones, and link with
 Family Medicine             appropriate resources
 Clinics)

                                                                                              Page 7 of 81
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Programme               What it does                                          Who will benefit

 Dementia-                  Promote the concept of Dementia-Friendly          General public on
 Friendly                    Community (DFC) and dementia awareness            dementia awareness
 Singapore                  Empower and collaborate with community
                             stakeholders and partners to implement            At risks seniors,
                             dementia-friendly      initiatives by   sharing   Person living with
                             resources and best practices to achieve           dementia, Caregivers
                             prevention, early identification and care &
                             support                                           Partners who are keen
                            Connect partners to explore synergy in            to create a dementia-
                             supporting the community needs                    friendly environment
 Night Respite              Provides respite for caregivers of persons with   Persons with dementia
 (put on hold till           dementia with sundowning behaviour through        displaying sundowning
 further notice)             caregiver education and support in managing       behaviour and have
                             sundowning behaviour, including home visits       difficulties sleeping at
                             to assess caregivers’ needs and identifying       night. Clients should
                             any caregiver-related issues such as stress or    have a diagnosis for
                             burnout.                                          dementia, and
                            Engages persons with dementia meaningfully        assessed to have at
                             during the night respite session through          least mild or moderate
                             assistance with ADLs and cognitive                dementia.
                             stimulating activities and tasks
                                                                               Long-term caregiver of
                                                                               a person with
                                                                               sundowning behaviour.
 Go Respite                 Help caregivers to plan and identify services     Caregivers who
                             ahead of time                                     requires short term
                            Complete some administrative processes            respite break from
                             early, e.g. assessment of eligibility for         caregiving for their
                             subsidies                                         elderly loved ones or
                            Activate respite care more quickly when it is     when foreign domestic
                             needed                                            worker goes on home
                                                                               leave
 Post-Diagnostic            Help caregivers of loved one with                 For persons newly
 Support -                   dementia to understand the condition              diagnosed with
 Dementia                   Facilitate early planning and management          dementia and their
                                                                               caregivers for first six
                             of the disease
                                                                               months upon the
                            coordinate community resources to
                                                                               referral.
                             support person-centred care

For case referral /escalation for persons with or at risk of mental health conditions, please write in to
careinmind@aic.sg.

                                                                                              Page 8 of 81
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CREST (Community Resource, Engagement & Support Team)
The Community Resource, Engagement and Support Team (CREST) Is a community outreach team
that serves as a community safety network for people with and/or at risk of mental health conditions
such as depression, dementia and others. CREST also supports the clients’ caregivers with resources
they need to continue to care for their loved ones at home and in the community. Left on their own,
clients and their caregivers may not recognise the signs and symptoms of mental health conditions
or know where to seek help, and may delay treatment. Therefore, CREST is the community node
linking clients and their caregivers to appropriate health and social support networks.
The CREST team comprises of social service professionals with social work background or equivalent
and community liaison coordinators to provide the following services:
     Raise public awareness of mental health through outreach events to residents and caregivers
      within the assigned regions
     Promote the recognition of early signs and symptoms of mental illnesses
     Regular home visits to clients and their caregivers
     Provide coordinated person-centric care (social and health), information and support for clients
      and caregivers through providing basic emotional support, follow up and service linkage
     Network, engage community partners and coordinate mental health training and education

Over and above these core services, some CREST also provide specialized services such as
preventive activities to reduce the risk of mental illness or dementia, caregiver services or lead in the
Dementia Friendly Communities.

Target Population
CREST will serve adults and seniors, living in their catchment region:

     Adults and seniors that may be at risk or suspected or diagnosed with dementia, mental health
      conditions like depression;
     CREST will also support the caregivers;
     On a case-by-case basis, CREST can support clients living outside of the service boundary.

                                                                                              Page 9 of 81
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List of CREST Programme Providers

 Region       Service Providers                   Catchment Area

 East         AMKFSC Community Services           Pasir Ris East, Pasir Ris West, Pasir
                                                  Ris Central, Punggol Coast, Shore and
                                                  West, Fernvale, Rivervale,
                                                  Compassvale, Anchorvale , Buangkok

              Brahm Centre                        Tampines Central and Changkat,
                                                  Changi Simei, Tampines North and
                                                  East

              Montfort Care                       Bedok Reservoir-Punggol, Eunos, Kaki
                                                  Bukit, Siglap,Bedok

              The Salvation Army – Peacehaven     Fengshan

              Filos Community Services            Kampong Chai Chee

              Fei Yue Community Services          Paya Lebar, Serangoon, Hougang SMC
                                                  and "Punggol" of Bedok Reservoir-
                                                  Punggol

              ClubHEAL                            Pasir Ris and Tampines

 Central      AMKFSC Community Services           Bishan East-Sin Ming, Kebun Baru,
                                                  Marymount, Teck Ghee
              AWWA                                Yio Chu Kang
              Brahm Centre                        Macpherson SMC
              Care Corner Seniors Services Ltd    Toa Payoh (TPY) Central, TPY East,
                                                  TPY West Thomson
              Club Heal                           Geylang Serai
              Fei Yue Community Services          Queenstown, Buona Vista
              Filos Community Services            Kembangan Chai Chee
              NTUC Health Co-Operative            Henderson- Dawson
              Thye Hua Kwan Moral Charities       Tanjong Pagar
              Methodist Welfare Services -        Macpherson SMC
              Charis ACE
              Montfort Care                       Joo Chiat, Kreta Ayer-Kim Seng and
                                                  Tanjong Pagar Tiong Bahru,Marine
                                                  Parade,Moulmein Cairnhill, Radin Mas
              Singapore Anglican Community        Kampong Glam
              Services
              O Joy Limited                       Kolam Ayer and Whampoa

              St. Hilda’s Community Services      Mountbatten
              Centre

                                                                                     Page 10 of 81
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Viriya Community Services           Braddel Heights and Potong Pasir

              AMKFSC Community Services           Teck Ghee, Jalan Kayu,Kebun Bahru
              AWWA                                Yio Chu Kang , Canberra and
 North                                            Sembawang Central,Woodlands,
                                                  Sembawang West
              Club HEAL                           Marsiling, Woodgrove , Admiralty
              Montfort Care                       Nee Soon Central and East, Chong
                                                  Pang, Nee Soon South, Yishun Link

              TOUCH Community Services            Cheng San-Seletar
              Limited

 West         Fei Yue Community Services          Ulu Pandan and Clementi, ZhengHua,
                                                  Bukit Panjang SMC , Cashew,
                                                  Brickland and CCK
              NTUC Health Co-Operative            Boon Lay and Jurong Spring,Keat Hong
                                                  and Taman Jurong
              Montfort Care                       Telok Blangah
              Singapore Anglican Community        Jurong Central and Yu Hua SMC, Bukit
              Services                            Batok East and BB East SMC
              Trans Family Services               Bukit Timah
              Reach Community Services            Hong Kah North, Bukit Gombak
              Society

              Viriya Community Services           Ayer Rajah-Gek Poh, West Coast,
                                                  Nanyang , Pioneer

 Island-      Alzheimer’s Disease Association
 wide         **

              CREST CG (ClubHEAL)

              Caregivers Alliance Limited – CG

              Silver Ribbon Singapore

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CREST-Youth
(Community Resource, Engagement and Support Team for Youth)

CREST-Youth serves as a basic community safety network for youths at-risk or with mental health
conditions and their caregivers who need the additional support to care for their loved ones in the
community. It is the community node linking the youth and their families to the appropriate health
and social support networks.

Key objectives:
    Increase public awareness of mental health by organising outreach events for the youth
      population, as well as those in their circles of support.
    Promote the recognition of early signs and symptoms of mental health conditions.
    Provide coordinated person-centric care (social and health), information and support for
      youths and their caregivers through providing basic emotional support, follow up and service
      linkage.
    Involve parents and peers in the recovery journey of youths.

Target Population:
    Youth aged 12-25
    Youth with mild mental health issues, or at-risk of developing mental health issues
    Caregivers of youth with mild mental health issues, or at-risk of developing mental health
       issues

Service Elements:
    Outreach and education
    Early identification, Basic Emotional Support, Service Linkage and Monitoring
    Youth peer support / youth-for-youth initiatives

List of CREST-Youth Programme Providers

 Region Served          Service Providers
 East                   Fei Yue
 Central                Team setup in progress
 North                  Care Corner INSIGHT
 North-East             Limitless
 West                   SHINE Children and Youth Services
                        (Clementi)

                                                                                         Page 12 of 81
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COMIT (Community Intervention Team)
Community Intervention Team (COMIT) is an allied-health led, multi-disciplinary team made up of
counsellors, occupational therapists, psychologists, nurses and programme coordinators. Embedded
in the community, COMIT aims to provide holistic support for clients with mental health or dementia
needs and their caregivers so that they can remain in the community for as long as possible.

Most importantly, the team is able to provide timely intervention and assessment of clients with mental
health needs and support the General Practitioners (GPs) for long-term monitoring to ensure clients
remain on track in their recovery journey.

COMIT teams were developed with the core function of delivering mental health interventions, and
different diagnosis require different forms of interventions to enable and empower clients with regards
to their functioning, symptom management, and relapse prevention. Given that COMIT teams serve
anyone with mental health needs from aged 16 and above, the additional element of individualized
needs come into play. This further emphasizes the importance of COMIT teams’ ability to deliver a
whole suite of services, from psychoeducation, to case management, as well as counselling and
psycho-social rehabilitation.

The types of services provided by COMIT are:
    Perform needs assessments of clients and caregivers
    Develop individualized care plans for clients and caregivers in the community, in close
       collaboration with health and social care providers
    Counselling and other psychosocial therapy for clients and caregivers
    Home visits for assessment and follow up support for clients and caregivers in the community
    Post-discharge support for continuity of care in the community
    Provide case management, care coordination and service linkages for clients and caregivers
       to appropriate services based on their needs
    Training and outreach to improve awareness and understanding of mental disorders for the
       general public

                                                                                           Page 13 of 81
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List of COMIT Programme Providers

       Region         Service Providers           Catchment Area
       Central        AMKFSC Community            Marymount SMC, Bishan East- Sin Ming
                      Services

                      Clarity                     In-Centre Counselling only in Central region
                      COMIT - MASS Montfort       Kolam Ayer,Toa Payoh-East, Toa Payoh West-
                      Care @ Central              Thomson, Toa Payoh Central
                      Montfort Care COMIT @       Queenstown, Buona vista,Henderson-Dawson,,
                      Telok Blangah               Radin Mas SMC
                      MONTFORT CARE @             Tanjong Pagar Tiong Bahru, Kreta Ayer-Kim
                      KRETA AYER                  Seng, Kampong Glam, Moulmein Cairnhill
                      Singapore Association of    Kolam Ayer, Macpherson SMC, Toa Payoh
                      Mental Health               Central, Whampoa, Toa Payoh-East, Braddel
                                                  Heights, Toa Payoh West-Thomson, Potong
                                                  Pasir SMC
                      Tsao Foundation             Queenstown , Tanjong Pagar Tiong Bahru, Kreta
                                                  Ayer-Kim Seng
                      AMKFSC Community            Jalan Kayu, Teck Ghee, Yio Chu Kang SMC, Ang
       North          Services                    Mo Kio- Hougang, Fernvale, ChengSan-Seletar,
                                                  Kebun Bahru SMC,
                      Clarity Singapore           In-Centre Counselling only in northern region
                      Club Heal                   Woodlands,Sembawang West,Marsiling,
                                                  Woodgrove, Admiralty
                      Fei Yue Community           Yew Tee, Lim Bang
                      Services
                      Singapore Anglican          Chong Pang, Nee Soon South, Nee Soon
                      Community Services          Central, Nee Soon East, Sembawang Central,
                                                  Nee Soon Link, Canberra,Kebun Bahru SMC
                      Montfort Care               Chong Pang, Nee Soon South, Nee Soon Link,
                                                  Sembawang Central, Canberra,Nee Soon East,
                                                  Nee Soon Central
       West           Singapore Anglican          Bukit Batok East, Bukit Batok SMC, Bukit
                      Community Services          Panjang SMC,ZhengHua, Cashew, Ulu Pandan,
                                                  Bukit Timah
                      SAMH                        Boon Lay, Clementi, Hong Kah North SMC,
                                                  Jurong Central , Yuhua SMC, Pioneer SMC,
                                                  Jurong Spring, West Coast, Ayer Rajah-Gek Poh
                      Fei Yue Community           CCK,Brickland,Keat Hong, Taman Jurong, Bukit
                      Services                    Gombak

                      COMIT Tsao                  Telok Blangah
                      Montfort Care COMIT @       Telok Blangah
                      Telok Blangah
                      Singapore Association of     Hong Kah North SMC, Clementi, Yuhua SMC,
                      Mental Health               Jurong Central, Jurong Spring, West Coast, Boon
                                                  Lay, Ayer Rajah-Gek Poh, Pioneer SMC
                      St Luke’s Hospital          Boon Lay, Clementi, Hong Kah North SMC,
                                                  Jurong Central , Yuhua SMC, Pioneer SMC,
                                                  Bukit Batok East, Bukit Batok SMC, Bukit
                                                  Panjang SMC, ZhengHua, Cashew, Ulu Pandan,
                                                  Jurong Spring, Nanyang, West Coast,
                                                                                     Page 14 of 81
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CCK,Brickland,Keat Hong, Taman Jurong, Bukit
                                                    Gombak
                      Viriya Community              Boon Lay, Pioneer SMC , Nanyang
                      Services COMIT
                      Viriya Community              Ayer Rajah-Gek Poh (Western region)
                      Services MASS
       East           AMKFSC Community              Compassvale, Punggol Shore, Anchorvale,
                      Services                      Rivervale, Hougang SMC, Punggol West SMC,
                                                    Punggol Coast, Buangkok, Serangoon
                      Brahm Centre                  Tampines North, Tampines East, Tampines
                                                    West, Tampines Central,Tampines Changkat,
                                                    Changi Simei
                      Singapore Anglican            Pasir Ris East, Pasir Ris West, Pasir Ris Central,
                      Community Services            Tampines Changkat, Tampines North, Tampines
                                                    East, Tampines Central, Tampines West
                      SAMH                          Serangoon, Paya Lebar

                      Filos Community Services      Kampong Chai Chee

                      Montfort Care                 Bedok-Reservoir-Punggol, Eunos, Kaki Bukit,
                                                    Fengshan, Bedok, Siglap
       Island-        Alzheimer’s Disease
       wide           Association
                      Club      HEAL     (Western
                      region )
                      **targeting the Malay
                      population

                                                                                          Page 15 of 81
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Youth Integrated Team

Youth Integrated Teams are allied health led teams in the community providing assessment and
intervention, while engaging youths for ongoing monitoring and support. The teams will work
actively with other youth agencies, schools and community partners to provide holistic case
management for the youths and their families.

Key objectives:
    Increase awareness of mental health through targeted outreach to youth at higher risk for
      mental health conditions, their families and their support systems
    Promote the recognition of early signs and symptoms of mental health conditions.
    Provide coordinated person-centric care (social and health), intervention and support for
      youths and their caregivers through providing assessments, therapeutic interventions and
      case management.
    Engaging community and healthcare partners to build a supportive environment for youths
      with mental health issues through active collaborations and co-management of cases.
    Facilitate the formation of supportive relationships with families and peers in the recovery
      journey of youths.

Target Population:
    Youth aged 12-25
    Youths at-risk of, displaying signs and symptoms of, or diagnosed with mental health
       conditions
    Caregivers of youths at-risk of, displaying signs and symptoms of, or diagnosed with mental
       health conditions

Service Elements:
    Outreach and education
    Early identification & Assessment
    Case Management
    Therapeutic Intervention
    Maintenance & Monitoring
    Family Work
    Youth peer support / youth-for-youth initiatives

       Region         Service Providers           Catchment Area
       Central        YIT TOUCH @ Central         Central region (supporting North and West
                                                  CREST-Youths – SHINE & Care Corner)

       East           YIT SAMH @ East             Eastern region (supporting North-East and East
                                                  CREST-Youths – Fei Yue & Limitless)

                                                                                      Page 16 of 81
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Aftercare

Aftercare programme aims to provide transitional care support through case management approach
to optimise functioning including sustaining the psychological well-being of clients with complex
needs, as well as to re-integrate them back into the community. It focuses on the development of a
structural framework to identify & monitor identified clients. This includes steering a systemic
mechanism of partnership to enable and leverage on the strength of the healthcare providers and
community partners to work together to provide better intervention and support to the clients’ and
caregivers’ through a case management approach.

Aftercare focuses on collaborative transitional care approach and helps streamlining client’s
transitional process between acute hospital and community partners. Aftercare clients would benefit
from transitional care to improve on their health outcome and ultimately, reduce re-admission and
enable clients to stay well in the community with appropriate community support. Clients are identified
from the hospital system through a set of criteria such as focusing on frequent relapse episodes, and
or with two or more needs (complex needs). After which, they are screened by Aftercare Case
Manager (ACM) for consent to engage in the collaborative and coordinated case management.

Type of services provided by Aftercare Case Managers include:

       Single Point of Contact between community partners and restructured hospital
       Joint home visit(s) for assessment and community support
       Facilitate information flow amongst the stakeholders within the Integrated Health (Mental and
        Physical Health) & Social Support Network
       Lead role to provide one care plan to be shared with RH and partners
       Resource person for services and provide service linkage through working closely with the
        frontline agencies
Currently, the Institute of Mental Health (IMH) is the main provider for the Aftercare Programme,
supporting the clients’ needs in collaboration with our community partners. There are 4 pilot sites
identified at this juncture:

 Pilot Sites                           Service Providers

 AMK-SinMing                           AMKFSC Community Services

 Kembangan-Chai Chee (KCC)             Filos Community Services

 Kreta Ayer                            Montfort Care

 Macpherson                            Singapore Association for Mental Health (SAMH) and
                                       Brahm Centre

These 4 Aftercare pilot sites are unique in their local support network to cater to the diverse needs of
the clients and caregivers. This network provides close support to the clients residing in respective
service boundaries and would often have a platform for case conferences to discuss the needs and
for updates.

                                                                                            Page 17 of 81
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ASCAT (Assessment & Shared Care Team)
  ASCAT is a physician-led, multi-disciplinary team, comprising of psychiatrist or mental health doctors
  and allied health professionals including nurses and therapists, to provide treatment and care to
  clients from mild to severe mental health conditions.
  ASCAT aims to provide assessment, treatment and care for patients from moderate to severe mental
  health conditions such as depression, anxiety and sleeping disorders. The clients’ health (e.g. chronic
  conditions and mental health) can be managed holistically within the community instead of in different
  care settings. The mental health component will include mental health assessment, medication,
  psychotherapy and any other intervention where appropriate as provided by a multi-disciplinary team.
  ASCAT provides the following:
   Provide clinical care, assessment, diagnosis, stabilization and treatment for clients with mental
      conditions
   Build capability of providers including primary care physicians for example, GPs and community
      agencies to provide quality mental health care through training and professional support
   Develop community support initiatives and provide clinical leadership in the development of
      integrated community mental health network

  Details of ASCAT Programme Providers can be found in Annex A.

ASCAT Service Providers                                    Eligibility Criteria Location & Contact
North        ASCAT@North THRIVE is set up by               Eligibility Criteria     Location: Khoo Teck Puat
(ASCAT       the Khoo Teck Puat Hospital as part of         Adults aged 16         Hospital, 90 Yishun Central,
@North)      the integrated care partnership to                and above            Singapore 768828
Thrive       assist clients in getting the right kind of    Singaporeans           Appointment line: 6555 8828
(KTPH)       mental care as well as facilitate their           and                  Email     for   appointment:
             management and recovery in the                    Permanent            ktph.appt@ktph.com.sg
             community. THRIVE stands for Total                Residents
             Health Rich In Vitality & Energy.
Central      ASCAT@Central led by Institute of             Eligibility Criteria     Location: 10 Buangkok View,
(ASCAT       Mental Health is part of the integrated        Adults aged 16         Buangkok Green Medical
@            community mental health network in                and above            Park, Singapore 539747
Central)     the Central Region that provides fast          Singaporeans           Appointment line: 6389 2200
IMH          track clinical service and support to             and                  Email: imh_appt@imh.com.sg
             clients for greater accessibility to care.        Permanent
             The team works closely with primary               Residents
             care providers and VWOs to facilitate
             management of stabilized clients in
             the community.
West         ASCAT@NUHS                   is         an     Eligibility Criteria    Location: 5 Lower Kent Ridge
(NUH)        adult community psychiatric team that          Adults         aged    Road, Singapore 119074
             is led by National University Hospital            between         18   Appointment Line: 9230 4143
             system.       The       team       provide        and 65 years         Email:
             assessment        and     treatment      of       old                  nuhascat@nuhs.edu.sg
             psychiatric conditions and help
                                                                                                    Page 18 of 81
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  Updated as at June 2021
ASCAT Service Providers                             Eligibility Criteria Location & Contact
             patients to navigate through the wide    Singaporeans
             range of services in both hospital and    and Permanent
             the community.                            Residents

West         ASCAT@NTFGH led by Ng Teng Eligibility Criteria           Location: Ng Teng Fong
(NTFGH)      Fong General Hospital provides  Adults aged 16           General Hospital
             clinical care for clients with mental   and above         Appointment Line: 6716 2222
             issues.                                Singaporeans      General enquiries: 6716 2000
                                                     and Permanent     CMH      Email       address:
                                                     Residents         JHCampus_CMH_Programm
                                                                       e@nuhs.edu.sg

East         ASCAT@CGH led by Changi General Eligibility Criteria      Location:
(CGH)        Hospital provides fast track clinical  Adults aged 18    Changi General Hospital
             assessment and treatment                and above         Dept      of     Psychological
                                                    Singaporeans      Medicine
                                                     and               2 Simei Street 3
                                                     Permanent         Singapore 529889
                                                     Residents

                                                                                        Page 19 of 81
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  Updated as at June 2021
Mental Health in Primary Care
Mental health in primary care aims to bring care closer to home and improve access to mental health
services in a less stigmatising environment. Clients with mild to moderate mental health and chronic
health conditions will be able to seek holistic treatment in a primary care setting, i.e. at General
Practitioner (GP) clinics, Polyclinics and Family Medicine Clinics (FMCs).

Services
 Provide consultations, diagnosis and treatment for clients with physical health needs and mild to
   moderate mental health conditions

    Provide co-management through team-based approach involving medical and allied health
     services

     a) Mental Health General Practitioners Partnership (GP Partnership)
     GP Partners are medical doctors who provide both medical and physical health assessments. The
     GP Partners also provide medications for clients who require psychiatric medical interventions.
     Refer to Annex A for list of GP Partners.

     b) Mental Health in Polyclinics Programme

    The Mental Health in Polyclinics Programme consists of doctors, psychologists, medical social
    workers and nurses. They work together to support the polyclinics’ patients with mild to moderate
    mental health conditions. With a multi-disciplinary team, clients with mental health/dementia and
    chronic physical conditions can be managed within the polyclinics.

    Please call respective polyclinics’ general appointment line to make appointment for
    consultation. Client will only be referred to mental health or memory clinics as determined
    by polyclinic doctor upon consultation.

         Service Providers                    Mental Health   Memory      Contact Details
                                              Clinics         Clinics
    1.   Ang Mo Kio Polyclinic                      √             √       National     Healthcare
                                                                          Group Polyclinics Call
    2.   Woodlands Polyclinic                       √             √
                                                                          Centre
    3.   Yishun Polyclinic                          √             √       Appointment Line:
                                                                          6355 3000
    4.   Toa Payoh Polyclinic                       √             √
    5.   Hougang Polyclinic                         √             √
    6.   Geylang Polyclinic                                       √
    7.   Jurong Polyclinic                          √             √       National      University
                                                                          Polyclinics Call Centre
    8.   Choa Chu Kang Polyclinic                                 √
                                                                          Appointment Line:
    9.   Pioneer Polyclinic                         √             √

                                                                                         Page 20 of 81
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Service Providers                     Mental Health   Memory    Contact Details
                                              Clinics         Clinics
  10. Bukit Batok Polyclinic                        √             √     6663 6847
  11. Queenstown Polyclinic                         √
  12. Outram Polyclinic                             √             √     SingHealth    Polyclinics
                                                                        Call Centre Appointment
  13. Tampines Polyclinic                           √             √
                                                                        Line: 6643 6969
  14. Bedok Polyclinic                              √             √
  15. Bukit Merah Polyclinic                                      √
  16. Punggol Polyclinic                            √

                                                                                      Page 21 of 81
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Annex A
List of GPs under General Practitioners Partners by Regions

CENTRAL REGION

 General Practitioners (GP)                             Tel No.
 Dr Lim Hong Shen
 A Medical Clinic                                       6226 2066
 1 Everton Park #01-27 S(081001)

 Dr Fairuz Bin Ahmad
                                                        6547 8840
 HeartlandHealth 88 Circuit Road #01-965 S(370088)

 Dr Kwan Wai Chee Grace
 Bishan Grace Clinic                                    6254 2232
 150 Bishan Street 11 #01-151 S(570150)
 Dr Wong Mei Chun
 C.M.C Wong Binjai Clinic                               6469 3737
 15 Binjai Park S(589824)
 Dr Cheong Siew Meng James
 C3 Family Clinic @Aljunied Crescent                    6742 2285
 95 Aljunied Crescent #01-509 S(380095)
 Dr Eng Soo Kiang
 C3 Family Clinic @Aljunied Crescent                    6742 2285
 95 Aljunied Crescent #01-509 S(380095)
 Dr Tan Mui Yen June
 C3 Family Clinic @Aljunied Crescent                    6742 2285
 95 Aljunied Crescent #01-509 S(380095)
 Dr Jee Yong Hing
 C3 Family Clinic @Aljunied Crescent                    6742 2285
 95 Aljunied Crescent #01-509 S(380095)
 Dr Tan Puay Wee Steve
 Calrose Medical Family Clinic                          6957 1750
 231A Sumang Lane, #01-05 Matilda Court S(821231)
 Dr Lim Geok Leong
 Central Medical Group Pte Ltd                          6272 2212
 11 Jalan Bukit Merah #01-4442 S(150011)
 Dr Chang Chean Seng Stephen
 Chang Clinic & Surgery                                 6221 6955
 Blk 7 Everton Park #01-21 S(080007)
 Dr Chang Tou Liang
 Chang Clinic                                           6466 3811
 1 Jalan Anak Bukit #B1-08 S(588996)

                                                                  Page 22 of 81
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General Practitioners (GP)                                           Tel No.
 Dr Cheng Heng Lee
                                                                      6454 2482
 Cheng Clinic
 447 Ang Mo Kio Avenue 10 #01-1677 S(560447)
 Dr Oh Cher Ming
                                                                      6225 5155
 Chinatown FMC
 133 New Bridge Road #02-09/10 Chinatown Point S(059413)
 Dr Yeo Cheng Hsun Jonathan
                                                                      6225 5155
 Chinatown FMC
 133 New Bridge Road #02-09/10 Chinatown Point S(059413)
 Dr Keong Kean Seng Gary
                                                                      6803 9375
 Dr Gary's Family Clinic
 77 Indus Road #01-523 S(160077)
 Dr Ang Boon Kian Steven Gregory
                                                                      6474 7333
 Dr Steven Ang Aesthetic & Family Clinic
 75D Redhill Road #01-112 S(154075)
 Dr Foo Winnie
                                                                      6475 4262
 Dr.W Medical Clinic
 8 Empress Road, #01-09 S(260008)
 Dr Pang Sze Kang Jonathan
                                                                      6385 0815
 Everhealth Medical Centre
 540 Hougang Avenue 8 #B1-1235 S(530540)
 Dr Wong Ming
                                                                      6385 0815
 Everhealth Medical Centre
 540 Hougang Avenue #B1-1235 S(530540)
 Dr Lily Lie
 Everton Clinic                                                       6220 7872
 7 Everton Park #01-17 S(080007)
 Dr Ng Chee Lian Lawrence
                                                                      6449 1606
 Family Medicine Clinic
 58 Marine Terrace #01-65 S(440058)
 Dr Teo Huiling
                                                                      6273 3603
 Fraser Medical Centre
 78A Telok Blangah Street 32 #01-07 S(101078)
 Dr Lim Hock Hin
                                                                      6288 1426
 Healthcare Medical Centre
 311 Hougang Avenue 5 #01-191 S(530311)
 Dr Lim Soon Aun Rodney
                                                                      6289 0885
 Healthlink Medical Clinic & Surgery
 5 Upper Aljunied Lane #01-46 S(360005)
 Dr Kay Aih Boon Erwin
                                                                      6734 5987
 Healthwerkz Medical Centre @ Orchard
 9 Scotts Road #11-02 Scotts Medical Centre Pacific Plaza S(228210)
 Dr Tan Sai Tiang                                                     6593 9530
                                                                                Page 23 of 81
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Updated as at June 2021
General Practitioners (GP)                                Tel No.
 Hua Mei Mobile Clinic, HMSCA
 298 Tiong Bahru Road, Central Plaza #15-01/06 S(168730)
 Dr Lim Khoon Boon Peter
 Joash Family Clinic and Surgery                           6282 7371
 1030 Upper Serangoon Road S(534767)
 Dr Lee Yi Jie Jack
 Katong Family Clinic                                      6203 4192
 Suites@Katong 263 Tanjong Katong Road #01-01 S(437050)
 Dr Sarah Jane Packer
 Katong Family Clinic                                      6203 4192
 Suites@Katong 263 Tanjong Katong Road #01-01 S(437050)
 Dr Tan Kian Wee Kenneth
 Kenneth Tan Medical Clinic                                6312 4589
 658 Punggol East, #01-07 S(820658)
 Dr Ko Hong Beng Gregory
 Ko Family Clinic                                          6842 1403
 18 Upper Boon Keng Road #01-1133 S(380018)
 Dr Lee Yik Voon
 Lee & Tan Family Clinic and Surgery                       6745 6877
 72 Circuit Road #01-03 S(370072)
 Dr Tan Peng Wee
 Lifelink 24Hrs Clinic & Surgery                           6281 3977
 153 Serangoon North Avenue 1 #01-534 S(550153)
 Dr See Shean Yaw
 Make-well Family Clinic & Surgery                         6253 4235
 70 Lorong Toa Payoh #01-351 S(310070)
 Dr Lee Choi Keong
 Maritime Medical Centre (Pte) Ltd                         6223 6066
 120 Cantonment Road Maritime House #02-03/06 S(089760)
 Dr Tham Kwong Lum
 Mediview Clinic and Surgery                               6253 2351
 150 Toa Payoh Lorong 1 #01-999 S(310150)
 Dr Foo Hsien Yang Joel
 Medlife Clinic & Surgery                                  6385 0836
 684 Hougang Avenue 8 #01-985 S(530684)
 Dr Ung Eugene
 Meridian Medical and Dental Centre                        6282 5205
 327 Hougang Avenue 5 #01-162 S(530327)
 Dr Tan Heng Kwang
 Neighbourhood Medical Clinic                              6386 8689
 Blk 683 Hougang Avenue 8, #01-901 S(530683)

                                                                     Page 24 of 81
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Updated as at June 2021
General Practitioners (GP)                                Tel No.
 Dr Koo Seng Long
 Newcastle Clinic                                          6736 2322
 541 Orchard Road Liat Towers #18-02A S(238881)
 Dr Phuah Wei Jan Melanie
 Nutramed Clinic                                           6735 0706
 1 Grange Road, Orchard Building #10-10 S(239693)
 Dr Ong Guan Hong
 Pancare Medical Clinic                                    6258 3186
 133 Ang Mo Kio Avenue 3 #01-1651 S(560133)
 Dr Kok Moo Ling
 Pancare Medical Clinic                                    6258 3186
 133 Ang Mo Kio Avenue 3 #01-1651 S(560133)
 Dr Goh Sze Yi
 Prudence Family Clinic                                    6251 5512
 512 Bishan Street 13 #01-524 S(570512)
 Dr Sunil Kumar Joseph
 Pulse Clinic Pte Ltd                                      6272 4145
 38 Beo Crescent #01-32 S(160038)
 Dr Liang Kai Lun Victor
 Q & M Mutual Healthcare Medical Clinic                    6384 6605
 Punggol MRT Station 70 Punggol Central #01-07 S(828868)
 Dr Suresh Mahtani
 S G Clinic                                                6382 1988
 84 Serangoon Garden Way S(555980)
 Dr Chua Boon Ling
 Simon Road Family Clinic                                  6287 8755
 9 Simon Road S(545895)
 Dr Tan May Yen Lilian
 Sims Drive Medical Clinic                                 6741 1607
 53 Sims Place, #01-174 Sims Vista S(380053)
 Dr Goh Xin Wei Ivanna
 Tan's T & T Clinic and Surgery                            6353 1133
 152 Bishan Street 11 #01-213 S(570152)
 Dr Sunil Kumar Joseph
 Tayka Medical                                             6392 4473
 29A Desker Road S(209562)
 Dr Teoh Che Chung
 Teoh Family Clinic Practice                               6255 5188
 Blk 47 Lorong 6 Toa Payoh #01-142 S(310047)
 Dr Arjunan Edward Kumanan Gratz
 The Clinic @ Aperia                                       6341 6892
 Aperia, 12 Kallang Avenue #03-15 S(339511)

                                                                     Page 25 of 81
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Updated as at June 2021
General Practitioners (GP)                                         Tel No.
 Dr Yong Yoke Kuen Christine
 The Clinic @ Campus                                                6333 9300
 SMU, 70 Stamford Road #B1-21 S(178901)
 Dr Lim Lok Houw Mervin
 The Clinic @ Campus                                                6333 9300
 SMU, 70 Stamford Road #B1-21 S(178901)
 Dr Erprini Prabhakar
 The Clinic @ Capitagreen                                           6384 6851
 Capitagreen, 138 Market Street #02-01A S(048946)
 Dr Aamir Ali Khan
 The Clinic @ Harbourfront                                          6353 2389
 Harbourfront Tower 2, 3 HarbourFront Place #04-01 S(099154)
 Dr Sukhvinder Singh
 The Clinic @ Marina One                                            6282 8518
 5 Straits View #01-07 S(018935)
 Dr Chong Wen Yu
 The Clinic @ One George Street                                     6438 5322
 1 George Street #05-05 S(049145)
 Dr Yo Masuya
 The Clinic @ Tai Seng                                              6333 9300
 SMU, 70 Stamford Road #B1-21 S(178901)
 Dr Lee Chong Han
 Trucare Medical and Surgery                                        6385 3525
 1187 Upper Serangoon Road #01-53, The Midtown, S(533971)
 Dr Tan Shi Ching
 Trucare Medical and Surgery                                        6385 3525
 1187 Upper Serangoon Road #01-53, The Midtown S(533971)
 Dr Lee Chong Han
 Trucare Medical and Surgery (AMK)                                  6255 8849
 Blk 226A Ang Mo Kio Avenue 1, Kebun Baru Mall, #01-631 S(561226)
 Dr Tan Shi Ching
 Trucare Medical and Surgery (AMK)                                  6255 8849
 Blk 226A Ang Mo Kio Avenue 1, Kebun Baru Mall, #01-631 S(561226)
 Dr Chan Shijie
 NTUC Health Family Medicine Clinic264 Serangoon Central #01-205    6281 2638
 S(550264)
 Dr Cheong Siew Meng James
 NTUC Health Family Medicine Clinic264 Serangoon Central #01-205    6281 2638
 S(550264)
 Dr Eng Soo Kiang
 NTUC Health Family Medicine Clinic264 Serangoon Central #01-205    6281 2638
 S(550264)

                                                                              Page 26 of 81
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General Practitioners (GP)                                        Tel No.
 Dr Tan Mui Yen June
 NTUC Health Family Medicine Clinic264 Serangoon Central #01-205   6281 2638
 S(550264)
 Dr Yeo Yu Lin Janine
 NTUC Health Family Medicine Clinic264 Serangoon Central #01-205   6281 2638
 S(550264)
 Dr Si Poh Nguan Cedric
 NTUC Health Family Medicine Clinic264 Serangoon Central #01-205   6281 2638
 S(550264)
 Dr Neo Hui Yee
 NTUC Health Family Medicine Clinic264 Serangoon Central #01-205   6281 2638
 S(550264)
 Dr Wong Alvin
 Well Family Clinic & Surgery                                      6454 9519
 555 Ang Mo Kio Avenue 10 #01-1948 S(560555)
 Dr Sim Tiong Peng
 Winsome Medical and Dental Centre                                 6254 4568
 81 Whampoa Drive #01-915 S(320081)
 Dr Ang Teng Soon Paul
 Zenith Medical Clinic Pte Ltd                                     6443 3678
 266 Punggol Way #01-374 S(823266)
 Dr Lily Lie
 Everton Clinic                                                    6220 7872
 7 Everton Park #01-17 S(080007)
 Dr Fairuz Bin Ahmad
 Heartland Health                                                  6547 8840
 88 Circuit Road #01-965 S(370088)
 Dr Xu Kuan
 57 Medical Clinic (Geylang Bahru)                                 6694 7078
 Blk 57 Geylang Bahru #01-3505 S(330057)
 Dr Lily Neo
 Lily Neo Clinic Pte Ltd                                           6472 6226
 101 Irrawaddy Road #21-09 S(329565)
 Dr Chen Shiling
 Hua Mei Clinic Whampoa                                            6661 9545
 300 Whampoa Drive, Whampoa Community Club #02-06 S(327737)
 Dr Lim Wen Siang Kevin
 Cornerstone Medical Bidadari                                      6707 5660
 Blk 106A Bidadari Park Drive, #01-03 S(341106)
 Dr Kok Moo Ling
 Pancare Medical Clinic                                            6258 3186
 Blk 133 Ang Mo Kio Ave 3 #01-1643 S(560133)
 Dr Ong Kong Yiow                                                  6451 1528
                                                                             Page 27 of 81
(Service Providers)
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Updated as at June 2021
General Practitioners (GP)                          Tel No.
 Healthcare AMK Medical Clinic
 157 Ang Mo Kio Avenue 4 #01-578 S(560157)

NORTH REGION

 General Practitioners (GP)                          Tel No.
Dr Koh Hang Yong
Citizen Family Clinic & Surgery                      6758 6188
102 Yishun Avenue 5 #01-117 S(760102)
Dr Jipson Quah
Mayfair Medical Clinic                               6235 2880
182 Woodlands Street 13 S(730182)
Dr Leong Yan Hoi
Millennium Medical Group                             6368 0386
849 Woodlands Street 82 #01-215 S(730849)
Dr Tan Yan Yuan
My Family Clinic (Angsana Breeze @Yishun)
                                                     6753 0178
507 Yishun Avenue 4 #01-05 S(760507)

Dr Muhammad Iqbal Bin Abdullah
Sembawang Mart Medical Centre Pte Ltd                6481 9793
511 Canberra Road #02-02A Sembawang Mart S(750511)
Dr Teow Kay Leong Roy
United Health Family Clinic                          6257 1182
627 Yishun Street 61 #01-63 S(760627)
Dr Yim Li-Jen Jean
Yim Medical Centre                                   6893 9181
678 Woodlands Avenue 6 #01-722 S(730678)
Dr Neoh Jia Quan Leon
Norwood Medical Clinic                               6937 3576
Blk 785E Woodlands Rise #01-02 S(735785)
Dr Loh Foo Keong Jeffrey
Lian Clinic                                          6269 7435
18 Marsiling Lane #01-S(730018)

EAST REGION

General Practitioners (GP)                           Tel No.

Dr Quek Koh Choon
Bedok Life Clinic                                    6443 1398
123 Bedok North Street 2 #01-160 S(460123)

                                                               Page 28 of 81
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Updated as at June 2021
General Practitioners (GP)                        Tel No.

Dr Chua Lee Lea Im
Bedok Medical Centre                              6241 4111
18 Bedok South Road #01-57 S(460018)
Dr Yeo Peng Hock Henry
Bedok Medical Centre                              6241 4111
18 Bedok South Road #01-57 S(460018)
Dr Lye Tong Fong
Central 24-Hr Clinic (Pasir Ris)                  6582 2640
446 Pasir Ris Drive 6 #01-122 S(510446)
Dr Chua Teo Ngee
Chua Medical Centre                               6785 3825
248 Simei Street 3 #01-134 S(520248)
Quah Soon Wee
Crossroads Family Clinic                          6592 7080
Blk 601B Tampines Avenue 9 #01-10 S(522601)
Dr Fong Chiu Yan
Eastern Medical Centre                            6448 7628
631 Bedok Reservoir Road #01-896 S(470631)
Dr Wong Toon Heng
Faith Medical Clinic & Surgery                    6788 1061
487C Tampines Street 45 #B1-103 S(522487)
Dr Fairuz Bin Ahmad
HeartlandHealth                                   6588 7833
730 Tampines Street 71 #01-51 S(520730)
Dr Cheng Kah Ling Grace
Joy Health Medical Clinic & Surgery               6781 1868
825 Tampines Street 81 #01-50 S(520825)
Dr Tay Kok Ling
K.L Tay Clinic & Surgery                          6448 1630
632 Bedok Reservoir Road #01-822 S(470632)
Dr Kay Aih Boon Erwin
KCS Medical Centre                                6443 8322
515 Bedok North Avenue 2 #01-205, S(460515)
Dr Foo Yew Sin Patrick
Little Cross Family Clinic                        6544 0040
929 Tampines Street 91 #01-445 S(520929)
Dr Muhd Azmi Hezan B Abd Latiff
Our Family Physician Clinic & Surgery             6785 0147
Blk 829 Tampines St 81 #01-292 S(520830)
Dr Kan Boon Thaim Eugene
Pasir Ris Clinic & Surgery                        6582 0502
442 Pasir Ris Drive 6 #01-28 S(510442)

                                                            Page 29 of 81
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Updated as at June 2021
General Practitioners (GP)                                 Tel No.

Dr Lim Geok Bin Joshua
Pasir Ris Clinic & Surgery                                 6582 0502
442 Pasir Ris Drive 6 #01-28 S(510442)
Dr Chua Thiam Eng
Siglap Clinic Pte Ltd                                      6348 8389
308 Telok Kurau Road #01-08 Vibes @ East Coast S(423858)
Dr Sajeena Abdul Azeesu Kunju
SM Haneefa Clinic                                          6243 4237
11 Chai Chee Road #01-23 S(460011)
Dr Chong Wai Yip
Trinity Medical & Aesthetic Clinic                         6260 2822
151 Simei Street 1 #01-33 S(520151)
Dr Wong Jee Pao
Wong Family Clinic & Surgery Pte Ltd                       6846 1613
117 Bedok Reservoir Road #01-68 S(470117)
Dr Yap Theresa
Yang & Yap Clinic & Surgery Pte Ltd                        6449 9946
537 Bedok North Street 3 #01-571 S(460537)
Dr Fairuz Bin Ahmad
Heartland Health                                           6588 7833
730 Tampines Street 71 #01-51 S(520730)

WEST REGION

General Practitioners (GP)                                 Tel No.

Dr Ling Chia Tien
Apex Medical Centre                                        6791 2292
960 Jurong West Street 92 @01-172 S(640960)
Dr Amir Adhha
Ar-Raudhah Medical Clinic                                  6567 7458
372 Bukit Batok Street 31 #01-386 S(650372)
Dr Sophian Hadi Ibrahim
Ar-Raudhah Medical Clinic                                  6567 7458
372 Bukit Batok Street 31 #01-386 S(650372)
Dr Kwek Thiam Soo
Bukit Batok Medical Clinic                                 6560 3311
207 Bukit Batok Street 21 #01-114 S(650207)
Dr Eng Soo Kiang
CCK Family Clinic                                          6891 0338
304 Choa Chu Kang Avenue 4 #01-653 S(680304)
Dr Lim Ying
                                                           6261 3629
Drs Koo, Fok & Associates (Joo Koon)
                                                                     Page 30 of 81
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Updated as at June 2021
General Practitioners (GP)                                       Tel No.

55 Benoi Road, Joo Koon Bus Interchange, #01-12 S(629907)

Dr Fok Wai Yee Rose
Drs Koo, Fok & Associates (Pioneer)                              6862 2380
31 Jurong West Street 63 #02-04 S(648310)
Dr Lim Ying
Drs Koo, Fok & Associates (Pioneer)                              6862 2380
31 Jurong West Street 63 #02-04 S(648310)
Dr Pradit Thonqudomporn
Drs Trythall, Hoy, Davies (Pte) Ltd - Jurong Point               6793 0611
1 Jurong West Central 2, Jurong Point B1-19B S(648886)
Dr Pang Sze Kang Jonathan
Everhealth Family Clinic & Surgery                               6793 3113
762 Jurong West Street 75 #01-290 S(640762)
Dr Wong Ming
Everhealth Family Clinic & Surgery                               6793 3113
762 Jurong West Street 75 #01-290 S(640762)
Dr Ong Tiong Hee David
Foo and Ong Family Clinic Pte Ltd                                6567 2212
151 Bukit Batok Street 11 #01-256 S(650151)
Dr Koh Thuan Wee
Frontier Family Medicine Clinic                                  6778 8362
3151 Commonwealth Avenue West #04-01, Grantral Mall, S(129581)
Dr Sim Kok Ping
Frontier Family Medicine Clinic                                  6778 8362
3151 Commonwealth Avenue West #04-01, Grantral Mall, S(129581)
Dr Thia Wee Keng Kevin
Frontier Family Medicine Clinic                                  6778 8362
3151 Commonwealth Avenue West #04-01, Grantral Mall, S(129581)
Dr Yong Yuan Chen
Healthlife Family Clinic                                         6904 8680
296A Bukit Batok Street 22 #01-64 S(651296)
Dr Bay Ee Lin Sharon
Healthsprings Medical Clinic                                     6892 6681
524A Jelapang Road #02-01 S(671524)
Dr Lim Chien Wei
Healthway Medical Clinic                                         6769 0600
Fajar Shopping Centre, 445 Fajar Road #02-524 S(670445)
Dr Chong Yan-Gerald Mark
Healthwerkz Medical Centre (CCK)                                 6766 2827
225 Choa Chu Kang Central, #01-199 S(680225)
Dr Goh Hsin Kai
                                                                 6766 2827
Healthwerkz Medical Centre (CCK)
                                                                           Page 31 of 81
(Service Providers)
For information, please write in to ccmh@aic.sg
Updated as at June 2021
General Practitioners (GP)                                        Tel No.

225 Choa Chu Kang Central, #01-199 S(680225)

Dr Kay Aih Boon Erwin
Healthwerkz Medical Centre (CCK)                                  6766 2827
225 Choa Chu Kang Central, #01-199 S(680225)
Dr Kok Zi Yin
Keat Hong Family Medicine Clinic                                  6769 0750
2 Choa Chu Kang Loop, Keat Hong Community Club #03-02 S(689687)
Dr Loke Kam Weng
Keat Hong Family Medicine Clinic                                  6769 0750
2 Choa Chu Kang Loop, Keat Hong Community Club #03-02 S(689687)
Dr Tan Jia Yeong Jeffrey
 Keat Hong Family Medicine Clinic                                 6769 0750
2 Choa Chu Kang Loop, Keat Hong Community Club #03-02 S(689687)
Dr Dharshini Puvanendran
Lakeside Family Medicine Clinic                                   6262 6434
518A Jurong West Street 52 #01-02 S(641518)
Dr Lim Boon Howe Edwin
Lakeside Family Medicine Clinic                                   6262 6434
518A Jurong West Street 52 #01-02 S(641518)
Dr Neo Hui Yee
Lakeside Family Medicine Clinic                                   6262 6434
518A Jurong West Street 52 #01-02 S(641518)
Dr Si Poh Nguan Cedric
Lakeside Family Medicine Clinic                                   6262 6434
518A Jurong West Street 52 #01-02 S(641518)
Dr Tok Sock Cheng
Lakeside Family Medicine Clinic                                   6262 6434
518A Jurong West Street 52 #01-02 S(641518)
Dr Lim Choo
LC Clinic Medical Surgery Aesthetics                              6464 0932
446 Clementi Avenue 3 #01-191 S(120446)
Dr Choo Chee Hoe Ivan
Lifecare Family Clinic                                            6769 8588
524A Jelapang Road #02-15 Greenridge Shopping Centre S(671524)
Dr Chin Yew Liang Alan
Lifeline Bukit Panjang Medical Clinic                             6760 5788
103 Gangsa Road #01-37 S(670103)
Dr Neow May Yin Pauline
Mei Ling Clinic                                                   6474 1782
158 Mei Ling Street #01-80 S(140158)
Dr Toh Beng Chye
                                                                  6765 6685
Millennium Medical Group
                                                                            Page 32 of 81
(Service Providers)
For information, please write in to ccmh@aic.sg
Updated as at June 2021
General Practitioners (GP)                                      Tel No.

533 Choa Chu Kang Street 51 #01-33 S(680533)

Dr Saiful Nizam Bin Subari
My Health Medical Centre                                        6872 6920
Blk 501 West Coast Drive, #01-256 S(120501)
Dr Lim Chew
Pier Medical Centre                                             6791 5677
725 Jurong West Avenue 5 #B1-164 S(640725)
Dr Kwong Kum Hoong
Princeton Family Clinic Pte Ltd                                 6762 2278
445 Fajar Road #01-546 Fajar Shopping Centre S(670445)
Dr Tan Swee Meng Robin
RC's Family Clinic Pte Ltd                                      6468 8006
635C Senja Road #01-03 S(673635)
Dr Sunil Kumar Joseph
Tayka Medical Family Clinic                                     6564 5528
526 Jurong West Street 52 #01-323 S(640526)
Dr Teo Tiong Kiat
Teo Clinic & Surgery Pte Ltd                                    6776 0216
352 Clementi Avenue 2 #01-111 S(120352)
Dr Gupta Ajeet Kumar
The Clinic @ Fusionpolis                                        6466 0602
Galaxis, 1 Fusionopolis Place #01-05G S(138522)
Dr Phan Oi Peng
The People's Clinic                                             6781 8030
145 Teck Whye Avenue #01-161 S(680145)
Dr Wu Eu Heng
Wu Clinic & Surgery                                             6561 1672
249 Jurong East Street 24 #01-78 S(600249)
Dr Xie Bo, Cindy                                                6256 5980
Healthway Medical
Blk 446 Bukit Batok West Avenue 8, #01-03 S(650446)
Dr Ho Kay Chun Caleb                                            9876 5330
216 Procross Medical Clinic
Blk 216 Boon Lay Ave #01-03 S(640216)
Dr Ho Kay Chun Caleb                                            8789 6779
405 Procross Medical Clinic
Blk 405 Jurong West Street 42 Hong Kah Court #01-K1 S(640405)
Dr Ho Kay Chun Caleb                                            9876 5297
411 Procross Medical Clinic
Blk 411 Jurong West Street 41 #01-K1 S(640411)
Dr Siaw Tung Yeng                                               6767 2281
Healthlight Family Medicine Clinic
                                                                          Page 33 of 81
(Service Providers)
For information, please write in to ccmh@aic.sg
Updated as at June 2021
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