General referral criteria

Referrals to specialist outpatient services within South West Hospital and Health service must be in writing and as a minimum contain the following:

Patient’s Demographic Details

∙ Full name (including aliases)
∙ Date of birth
∙ Residential and postal address
∙ Telephone contact number/s – home, mobile and alternative
∙ Medicare number (where eligible)
∙ Name of the parent or caregiver (if appropriate)
∙ Preferred language and interpreter requirements
∙ Identifies as Aboriginal and/or Torres Strait Islander

Refering Practitioner Details

∙ Full name
∙ Full address
∙ Contact details – telephone, fax, email
∙ Provider number
∙ Date of referral
∙ Signature

Relevant clinical information about the condition

∙ Presenting symptoms (evolution and duration)
∙ Physical findings
∙ Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
∙ Body mass index (BMI)
∙ Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
∙ Current medications and dosages
∙ Drug allergies
∙ Alcohol, tobacco and other drugs use

Reason for request

∙ To establish a diagnosis
∙ For treatment or intervention
∙ For advice and management
∙ For specialist to take over management
∙ Reassurance for GP/second opinion
∙ For a specified test/investigation the GP can’t order, or the patient can’t afford or access
∙ Reassurance for the patient/family
∙ For other reason (e.g. rapidly accelerating disease progression)
∙ Clinical judgement indicates a referral for specialist review is necessary

Clinical modifiers

Impact on employment
Impact on education
Impact on home
Impact on activities of daily living
Impact on ability to care for others
Impact on personal frailty or safety
Identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

∙ Willingness to have surgery (where surgery is a likely intervention)
∙ Choice to be treated as a public or private patient
∙ Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

Additional requirements

Individual specialties may require additional information to assist with assessment, diagnosis and treatment. Please ensure you check the information contained under the relevant specialty in the service list.

Including all of the above information will assist in a thorough assessment of the referral to ensure appropriate appointment scheduling.

If the referral does not contain sufficient information to accurately categorise the level of clinical urgency, it cannot be accepted and will be returned for further detail.

Sending your referral

Referrals can be sent via:
∙ fax
∙ posted letter or
∙ EReferral Template

All referrals must be signed by the referring practitioner. For the purpose of the electronic referrals a Public Key Infrastructure (PKI) constitutes as a signature.