20 June 2023

GPs looking to refer patients to hospital diabetes services are required to use the service referral form for the Local Government Area (LGA) where the patient resides.

Referral criteria

Diabetes referral forms may be used for case conferencing or specialist services under the following conditions.
  • GPs may refer a patient with type 2 diabetes for a case conference except when the patient meets the following circumstance or conditions:

    • Pregnant
    • Active foot ulcer
    • Paediatric (<18 years old)
    • Commercial driver’s license renewal
    • Clearance for surgery
    • On renal dialysis
  • The GP can refer a patient to a Diabetes Specialist Service if the patient meets at least one of the following criteria:

    • Anyone with Type 1 diabetes
    • Poorly controlled Type 2 diabetes (HbA1c >10%)
    • Significant and frequent hypoglycaemia or hypo unawareness
    • Diabetes and pre-pregnancy/pregnancy
    • Young adult with Type 2 diabetes (age <30 years old)
    • Diabetic foot ulcer requiring High Risk Foot Clinic
    • Advanced complications eg eGFR <45 ml/min, retinopathy/maculopathy undergoing treatment
    • Possible rare forms (eg possible MODY, Type 3c) and/or diagnosis uncertain (eg Type 1 diabetes)
    • Patients with diabetes commencing glucocorticoid therapy
    • Type 2 with learning difficulties or significant cognitive impairment
    • Type 2 diabetes with major mental illness and HbA1c > 9%
    • Pre-surgical stabilisation if HbA1c > 9 %, not known to endocrinologist, surgery planned within six weeks
    • Gestational diabetes mellitus

    Most patients with Type 2 diabetes will be managed by a diabetes specialist service for a defined period of time and then discharged to their GP for ongoing care. These patients can then be re-referred if referral criteria is met again.

  • Type 2 diabetes drivers licence clearance should be referred to a private endocrinologist.

  • Pre-surgery diabetes stabilisation should be coordinated between the GP, the surgeon and the patient’s endocrinologist ahead of the surgery, and not via case conferencing.

Referral forms

Diabetes service referral form – Bankstown Hospital

GPs may refer a patient living in the Bankstown-Lidcombe hospital catchment area to a diabetes specialist for group education, individual allied health/nursing review, or a medical review using this form.
Referrals accepted via fax only 9722 8366.

Referral form set

 

Diabetes service referral form – Bowral Hospital

GPs may refer a patient living in the Wingecarribee catchment area for group education or a medical review using this form.

Referral form set

 

Diabetes service referral form – Fairfield Hospital

GPs may refer a patient living in the Fairfield catchment area to group education, individual allied health/nursing review or a medical review using this form.

Referral form set

 

Diabetes service referral form – Liverpool Hospital

GPs may refer a patient living in the Liverpool catchment area to group education, individual allied health/nursing review or a medical review using this form.

Referral form set

 

Diabetes service referral form – Macarthur catchment

GPs may refer a patient living in Campbelltown, Camden or Wollondilly catchment areas to group education or a medical review using this form.

Referral form set

 

Diabetes service referral form – Wollondilly catchment

GPs may refer people living with type 2 diabetes who reside in Wollondilly LGA to the SWSLHD Wollondilly Diabetes Program for a consultation with an endocrinologist or diabetes educator using this form.

Referral form set

These referral forms may be found using the Search Resource Library by selecting the Health topic: of Diabetes and the Content type: Form and Templates.