Standard Referrals

Referral Guide:

Advanced Clinical Practitioner and Matron Referral Guide

Advice & Guidance – User Guide

New Referrals – Work Request form

• Request Form: Work request form

Active Recovery:

• EMIS FORM: Adult Community Therapy Team Domicilary Rehabilitation V2 Aug 18

Anticoagulant:

• EMIS FORM: Anticoagulant Clinic Referral V2 Mar 18

Arthritis:

• EMIS FORM: Early Inflammatory Arthritis Clinic V1 Apr 19

BCG:

• EMIS FORM: BCG Referral Form V1 Jun 15

Breathlessness:

• EMIS FORM: Breathlessness Clinic Referral form V1 Jun 18

Bone Mineral Destiometry (BMD):

• EMIS FORM: DEXA Referral Form V8 Sept 2019

Chest Pain:

• EMIS FORM: New Onset Chest Pain Clinic Referral V2 Jul 18

Chronic Fatigue Syndrome / ME:

• EMIS FORM: ME/CFS Referral Form V4 – Mar 19

Coeliac Disease:

• EMIS FORM: Suspected Coeliac Disease Referral Form V3 – Jun 17

Continence:

• EMIS FORM: Continence Referral Form V1 Nov 17
• EMIS FORM: Children’s Continence Service Referral Form V2 Mar 19

Diabetes:

• EMIS FORM: Diabetes XPERT & EPP V2 Jul 18

Echocardiogram:

• EMIS FORM: Echocardiogram referral form V4 Apr 19

Endoscopy:

• Stockport-endoscopy-flyer

Enhanced Case Management:

• EMIS FORM: ECM Referral Form V2 Nov 18
• EMIS FORM: Enhanced Case Management Goals of Care Record V1 Feb 18

ENT:

• EMIS FORM: ENT Rapid Access Clinic Referral Form – V1 Jul 17

Falls:

• EMIS FORM: Steady in Stockport Falls Bone Health V2 Jan 18 – Falls Service
• EMIS FORM: Steady in Stockport Falls Exercise Class Referral V1 Dec 17 – Exercise sessions run by Life Leisure designed to reduce falls risk

Gynaecology Service

• EMIS FORM: eRS Gynaecology criteria for GPs V1 Apr 19

Healthy Stockport:

• EMIS FORM: Healthy Stockport template V1 Jun 18

Heart Failure:

• EMIS FORM: Heart Failure Referral Form February 2021

Infectious Disease:

• EMIS FORM: Notification of Infectious Disease form V1 Feb 18

Leg Ulcer:

• EMIS FORM: Leg Ulcer referral V1 Dec 2017

Lymphoedema:

• EMIS FORM: Lymphoedema Service Referral Form V1 Apr 19

Mental Health:

• EMIS FORM: ASD ADHD referral form V1 Dec 18

Neuro-Rehabilitation:

• EMIS FORM: Community Neuro-Rehabilitation Service V1 Dec 18

Oxygen Assessment:

• EMIS FORM: Oxygen Assessment Referral Form V1 Mar 17

Palliative Care:

• Stockport-Specialist-Palliative-Care-Team
• EMIS FORM: Special Palliatve Care Team Referral V2 Aug 18

Paediatric General Surgery:

• EMIS FORM: Paediatric Surgery Notes for GPs
• EMIS FORM: Paeds Referral Guidelines SHH Info Sheet
• EMIS FORM: Promoting Paeds at SHH

Pathology:

• Blood Sciences Specimen Request Form
• Cell Path Specimen Request Form
• Microbiology Specimen Request Form

Podiatry/Orthotics:

• EMIS FORM: Podiatry Referral Form V6 May 19
• EMIS FORM: Orthotics Referral Form V1 Mar 16
• Managed Referrals Guidance - Podiatry

Psychological Medicine:

• EMIS FORM: Psychological Medicine Referral Form V2 Jan 19

Smoking Cessation:

• EMIS FORM: ABL Health Referral Form smoking Stockport V1 Dec18
• EMIS FORM: Smoking Cessation A Better Life Data Record Sheet GP V1 Jan 17

Speach and Language Therapy:

• EMIS FORM: Speech and Language Therapy V1 Jun 18

St Ann’s Hospice:

• EMIS FORM: St Ann’s Hospice Referral V2 Sept 18

Stockport Triage Assessment referral Team (START):

• EMIS FORM: START – Lifestyles form V5 June 18

Tissue Viability:

• EMIS FORM: Tissue Viability Referral Form V1 Feb 18

Transient ischaemic attack (TIA) 

• Transient ischaemic attack (TIA) Referral Form

Ultrasound:

• EMIS FORM: Ultrasound Referral Form – Beacon Medical Services V1 Jan 17
• EMIS FORM: USS – Ultrasound Referral Form – Stockport CCG V2 Dec 18
• EMIS FORM: USS – Ultrasound Referral Form – Under 18’s, Groin, Neck Lumps V2 Dec 18

Weight Management

• EMIS FORM: Adult weight management ref form V1 Apr 19
• EMIS FORM: Dietetics Referral form – V1 Dec 18

Wellbeing and independance in the community:

• EMIS FORM: WIN updated referral form V1 Sept 2017

Wheelchair Service:

• EMIS FORM: Wheelchair Service referral V3_Jun 18

X-Ray:

• EMIS FORM: X-Ray Request Form V1 Nov 17