This page contains a suite of EMIS templates that can be imported into your EMIS system. To access the templates, click on the links below. For information on how to import these into your EMIS system see the user guide below.
Templates:
These should be uploaded into EMIS as a template (see instructions above)
- Bichard Assessment V1 Dec 17
- FCPP – First Contact Practitioner Physiotherapy V4
- Goals of Care consultation form V1 June 2018
- Migrant Health Patient Check V1 Sep 18
- NHS England Pharmacist Patient Contact Template V1
- Safeguarding Adults V1 – Documenting concerns & mental capacity assessment
- Safeguarding Children V1 – Documenting concerns
- Stockport Chronic Disease Template V3 – Jan 18
- Stockport Diabetes Risk Monitoring Template V2 – June 17
- Stockport NHS Health Checks Template V4 – Mar 18
- Stockport Respiratory Disease Template V2 – June 17
- Stockport Smear Template V2 – June 17
Referral Forms:
These should be uploaded into EMIS as a document. Certain fields will then pre-populate.
- Active Recovery Referral (Community Therapists) V1_Jun 18
- Anticoagulant Clinic Referral – V2 Mar 18
- ASD ADHD Referral form V1 Dec 18
- Breathlessness Clinic Referral Form V1 – for joint assessment by cardiology/respiratory
- Community Neuro-Rehabilitation Service V1 Dec 18
- Continence Referral Form V1 Nov 17
- Children’s Continence Referral Form V2 Mar 19
- DEXA Referral Form V7 Mar 19 – For Bone Mineral Desitometry (BMD)
- Dietetics Referral form – V1 Dec 18
- Diabetes XPERT&EPP V2 Jul 18 – Type 2 Diabetes / Living with Long Term Health Conditions
- Echocardiogram Referral Form V3 – Jun 17
- Enhanced Case Management Referral Form V2 Nov 18
- Enhanced Case Management Goals of Care Record V1 Feb 18
- ENT Rapid Access Clinic Referral Form – V1 Jul 17
- Heart Failure Referral Form V3 – Jun 17
- Heart Failure 2 week fast track V3 – Jun 17
- Leg Ulcer Referral V1 Dec 17
- ME/CFS Referral Form V4 – Feb19 – offer evidence-based advice to people with ME/Chronic Fatigue Syndrome
- NAFLD Referral Letter V2 Dec 17 – Non Alcoholic Fatty Liver Disease
- New Onset Chest Pain Clinic Referral V2 Jul 2018
- Notification of Infectious Diseases V1 Feb 18
- Oxygen Assessment Referral Form V1 – Mar 17
- Podiatry Referral Form V3 Feb 17
- Psychological Medicine Referral Form V2 Jan 19
- Smoking Cessation Data Record Sheet V1
- Smoking Cessation A Better Life Referral Form V1
- Speech and Language Therapy Referral V1 Jun 18
- Special Palliatve Care Team Referral V2 Aug 2018
- Standard Referral Template V17
- St Ann’s Hospice Referral Form V2 Sept 18
- START – Lifestyles form V5 June 2018
- Steady in Stockport Falls Bone Health V2 Jan 18 – Falls Service
- Steady in Stockport Falls Exercise Class Referral V1 Dec 17 – Exercise sessions run by Life Leisure designed to reduce falls risk
- Suspected Coeliac Disease Referral Form V3 – Jun 17
- Tissue Viability Referral Form V1 Feb 18
- Ultrasound Referral Form – Beacon Medical Services V1
- USS – Ultrasound Referral Form – Stockport CCG V3 Dec 18
- USS – Ultrasound Referral Form – Under 18’s, Groin, neck lumps V2 Dec 18
- Wheelchair Service Referral V3 Jun 18
- WIN updated referral form V1 Sept 17 – Wellbeing and independence in the community
- X-Ray Request Form V1 Nov 17
Additional EMIS guidance and information:
If you have any problems please contact Andrew O’Donnell – andrew.odonnell@nhs.net