Refer to Healthpathways or local guidelines
Control co-morbidities
Please consider clinical modifiers and note as applicable (impact on employment / education / home / ADLs / ability to care for others / personal frailty or safety or identified as Aboriginal and / or Torres Strait Islander)
Does your patient meet the minimum referral criteria?
Category 1 If you feel your patient meets Category 1 criteria, please mark "urgent" on your referral |
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Category 2 (appointment within 90 calendar days) |
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Category 3 (appointment within 365 calendar days) |
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If your patient does not meet the minimum referral criteria
Reason for request
Relevant clinical information about the condition
Clinical modifiers
Patient's Demographic Details
Referring Practitioner Details
Other relevant information
Metro South Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro South Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.