Listed below is the mandatory information required for a referral request to be accepted and clinically prioritised.
Patient demographic information
- full name
- date of birth
- name of parent or carer (if applicable)
- address
- telephone number(s)
- email address
- alternative contact details
- preferred method of communication
- Medicare number (if eligible)
- Indigenous status (if applicable)
- any requirement to ensure cultural safety (including family violence safety)
- language other than English (if applicable), reliance on a carer, reliance on cultural, linguistic or disability support (e.g. need for an interpreter), reliance on transport support
- medial treatment decision-maker, support person or carer (if any)
- contact details for usual GP (if the GP is not the referring clinician)
Referrer demographic information
- full name
- address
- telephone and fax number(s)
- email address
- preferred method of communication
- Medicare provider number
Reason for referral
What is the main purpose of the referral:
- requesting services to establish a diagnosis, provide clinical assessment or inform a treatment plan
- requesting partnership care between the patient, GP and the health service (such as patients with chronic or progressive conditions that require ongoing specialist advice, or services to improve and optimise people’s function and participation in activities of daily living)
- requesting specific tests or investigations that cannot be ordered, accessed or interpreted through the primary care system
- requesting treatments or an intervention.
Presenting problem
- Indicate the presenting problem or working diagnosis and if the patient has received earlier services for the same presenting problem.
Service requested
- Indicate the clinic or service requested.
Required referral information
- date of referral
- indicate that the patient has agreed to the referral and agreed to share their personal and health information with the health service
- referring clinician’s assessment of clinical urgency
- required clinical information listed in any referral criteria for the resenting problem
Current patient management
Summary of current patient management including:
- current treatment
- previous treatment and response to this treatment
- complete and current medication list
- allergies and previous adverse events
- relevant medical history including any functional or cognitive impairment
- relevant family history
- relevant physical, psychosocial and structural barriers the person experiences which may impact on their access to services
- existing community support (if any)
- existing advance care directive (if any)
What is the impact of the problem on the patient?
List any functional impairments, impact on work, study or school, impact on caring responsibilities, social impact, impact on comorbidities and any other impact on the person’s quality of life.
Resources
HealthPathways Melbourne
- Email address: info@healthpathwaysmelbourne.org.au
- Website: HealthPathways Melbourne
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About:
HealthPathways Melbourne provides clinicians with a single website to access clinical and referral pathways, and resources. Pathways are created by local GPs, working in partnership with specialists, nurses, allied health and other health professionals.
Mercy Health recommends clinicians to access HealthPathways Melbourne for guidance in assessing, managing and referring for patient conditions (login required).
Referrals to outpatient clinics at Mercy Health will be triaged against clinical information and investigations based on these guidelines.
Referrals that do not meet the required clinical information and investigations will not be accepted.
HealthPathways Melbourne is available for free to health professionals working in the North Western Melbourne and Eastern Melbourne Primary Health Network catchments.
Email HealthPathways to request access or if you need to confirm your username and password.
Statewide Referral Criteria for Specialist Clinics - Victoria
- Website: Statewide Referral Criteria
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About:
The Department of Health and Human Services has developed statewide referral criteria to assist GPs and clinicians referring patients to specialist clinics. These referral criteria have been developed to improve access to specialist clinics in public hospitals by improving the quality and appropriateness of referrals.
Last reviewed October 30, 2019.