Required information
In order for us to be able to accept your patient for review and treatment, referring GP’s/Medical Specialists are required to provide the following detail in your referral.
Essential information
- full name
- address and phone numbers
- date of birth
- Indigenous status for patient and spouse
- referring GP details
- health insurance details
- preferred language and interpreter requirements
- Medicare eligibility & number
- mobility needs.
Clinical information
Current history:
- LNMP
- multiple pregnancies
- BMI
- EDD
- height and weight
- female circumcision
- parity and gravida
- pap smear.
Past history:
- preeclampsia
- small baby <2500g at term
- pre-term birth
- previous caesareans
- Rhesus isoimmunisation
- mid-trimester loss or miscarriage
- gestational diabetes
- miscarriages >3.
Medical history
Medical history:
- diabetes
- epilepsy
- thalassemia/haemoglobinopa-thy
- hypertension
- thyroid disease
- current smoker
- asthma
- anaemia
- DVT or pulmonary.
- previous cone biopsy
- high blood pressure
- psychiatric disorders
- heart disease
- illicit drug use
- alcohol and other drugs
- allergies.
Investigations and results
Required:
- FBE
- syphilis serology
- MSU/urinalysis
- hepatitis B and C
- blood group
- antibodies
- vitamin D
- dating ultrasound
- HIV serology
- rubella
- varicella
- morphology 20-week ultrasound
- ferritin
- thalassemia testing (if indicated by MCV ≤80)
- screening for Down syndrome if requested by the patient.
Referral process
Populate required information on the maternity referral form then print and fax to the relevant outpatient department on 03 8458 4205.
Step 1
Essential referral content will be checked. You will be contacted if further information is required.
Please indicate the patient’s preferred model of care on the referral form. If requesting an urgent review please include relevant detail and results.
Acknowledgment of referral receipt will occur within eight working days.
Step 2
The referral will be triaged by the specialist unit according to clinical criteria and patient preference.
This determines how long the patient will have to wait for their first antenatal appointment.
Step 3
Patients with urgent conditions are scheduled to be seen within 30 days. Patients are allocated an antenatal clinic appointment.
The date for the appointment will depend on the model of care and clinical acuity. Both the referrer and patient are notified.
If you have not received a response to your referral within eight working days, please phone our central booking office.
Phone: 03 8458 4111.
Additional information
The SAGE Clinic provides specialist multidisciplinary care for pregnant women with current or historical substance use, as well as patients using high doses of opioid analgesia.
If making a referral, please note the following:
- We provide obstetric care for pregnancy women who have a current or historical use of illicit substances, alcohol, pharmacotherapy or high level opioid analgesia
- Our team consists of obstetricians, midwives, social workers and mental health clinicians , with streamlined access to allied health and paediatrics when required
- Our midwives provide continuity of care and facilitate antenatal education with a focus on substance use and breastfeeding
- We offer comprehensive drug and alcohol assessments for patients
- Please include a history of your patients substance use to enable risk assessment and timely booking of initial antenatal appointments
Contact details
Referral contact details
Mercy Hospital for Women Maternity
Level 3, 163 Studley Road
Heidelberg Vic 3084
Phone: 03 8458 4111
Fax: 03 8458 4205
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