GP to GP colleague referrals

All fields are mandatory.
If urgent attention is required, please follow the relevant clinical guidance to best manage patient symptoms and refer to appropriate specialist/ED as required.
Info for referring and accepting GP: 
•	Referring GP to send completed form and all attachments to accepting GP via HealthLink, fax or secure messaging platform.
•	Referring GP is responsible for patients’ ongoing care.
•	Accepting GP is responsible for reviewing referral form and contacting patient to make an appointment only if they have capacity to do so. 
•	Accepting GP will assess patient then provide prescription for any medication/consumables required to complete treatment/procedure.
•	Accepting GP is expected to advise referring GP of outcome of assessment/procedure and any further actions required.

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Dear Dr <AdrName>
Thank you for seeing my patient for assessment and procedure as indicated below. 
Referring GP details*	
Name: <RefDetails>
Practice name: <Practice>
Practice address: <RefAddress>
Phone number:<RefPhone>
Email: <RefEmail>	Practice stamp

Provider number
<DrProviderNo>	

Patient details	
Patient Name:	<PtFullName>	Patient DOB:	<PtDoB>	
Patient Sex:	<PtSex>	Patient Contact Number:	<PtPhoneH>
<PtPhoneMob>	
Patient Emai:	<PtEmail>	Spoken Language:
If not English, is interpreter required?	<PtSpokenLanguage>
<InterpreterRequired>	
Is Patient Aboriginal or Torres Strait Islander?	<PtAboriginality>	Is Patient currently pregnant?	<PtCurrentlyPregnant>	
Known allergies:	<PtKnownAllergies>
			
Emergency Contact Name:	<NOKName>	Emergency Contact Phone:	<NOKContact>
<NOKContact2>	

Service Required	
<ReasonForReferral>

Additional Clinical Information	
<Clinical Information>	

Please provide any additional supporting documentation and relevant investigations with this referral form.
For information on local practitioners offering specialist GP services, please refer to General Practice (GP) Colleague Referrals - Community HealthPathways South Western Sydney.