NHS e-Referral Service - Referral Forms
These pro-formas are for referrals to Gloucestershire Hospitals Trust only.
• 2 week rule • Hearing Aid • Gynaecology • Cardiac Physiology • Renal • Orthopaedics • Orthopaedic Practitioners • Dietetics • Rheumatology • Diabetic Medicine • Sleep Service • General Information
2 Week Rule Referral Forms
All 2 week rule referrals must include the appropriate pro-forma as an attachment. The pro-forma contains the appropriate clinical information, reason for referral (letter text) and a section for basic patient information (name, date of birth, NHS number and NHS e-Referrals UBRN). This should be sent together with the practice's standard referral letter, which will contain full patient demographic information, practice details and items from the patient's medical reord if this has been set up. As all of this information can be automatically populated from the clinical system, it means that it will not have to be re-typed on the 2 week rule pro-forma. Both documents must be attached at the same time.
Please click on the browser 'Refresh' button before downloading any of the forms to ensure that the links are to the most recent versions.
It is recommended that these pro-formas can be downloaded and saved in an appropriate folder on your clinical server so that they can be used by all users within the practice.
Direct Access Hearing Aid Proformas
Gynaecology Pilot Services proforma
Cardiac Physiology Support Documents
Renal Service Support Documents
From 24th October 2011 all referrals to Hip/Knee and Spinal services should be made using one of the templates below.
Further information about the Pain, PHQ9 and GAD7 scores is available below:
Dietetics - Refractory IBS Service
One of the key components to a successful service is a good quality referral, we have designed an aid (based around the STOPBANG Questionnaire) to help you evaluate your patients risk and whether they may benefit from referral into the sleep service. To access it click on the link below.