Get Podiatry Referral Form

Filling out the Podiatry Referral Form online is an important step in facilitating care for patients in need of podiatric services. This guide will provide you with step-by-step instructions to ensure the form is completed accurately and efficiently.

Follow the steps to successfully complete the Podiatry Referral Form.

1. Click ‘Get Form’ button to access the Podiatry Referral Form and open it in your preferred digital editor.
2. Begin by entering the patient's name in the appropriate field. Ensure the name is spelled correctly for accurate record-keeping.
3. Next, input the NHS number. If the patient does not have this, consider providing alternative identification.
4. Fill in the patient's address, including the post code, to ensure proper communication.
5. Record the patient's date of birth and telephone number. Use a mobile number if available for faster contact.
6. Select the patient's gender by marking the corresponding box for either M (Male) or F (Female).
7. Indicate whether the patient is a military veteran by selecting 'Y' for Yes or 'N' for No.
8. Complete the mobile number field for additional contact methods.
9. Indicate if the patient has a registered carer by selecting 'Y' or 'N'.
10. Provide the practice address, including all relevant details for the patient's GP.
11. Input the GP's name, telephone number, and fax number for referrals.
12. Summarize the patient's medical history, specifically including any relevant conditions such as diabetes.
13. If the patient has diabetes, indicate if the Diabetes Foot Assessment (DFA) Form is attached. If so, mark 'Y' and follow the diabetic foot referral pathway as outlined.
14. Clearly state the reason for the referral. If the patient has current foot ulceration, provide a detailed description of the ulcer including location, size, wound bed description, and duration.
15. List the current antibiotic regime the patient is undergoing, if applicable.
16. Indicate if the patient has an ingrowing toenail or foot pain, marking 'Y' or 'N' for each condition.
17. If any pain exists, please specify if antibiotics have been prescribed and the level of pain (mild, moderate, or severe).
18. Provide a detailed description of the problem the patient is facing, ensuring to include as much relevant information as possible.
19. Fill out the details of the referrer, including name, correspondence address, designation, and the date of the referral.
20. Complete the forms by signing where indicated, ensuring the NHS.net address is noted, if applicable.
21. After verifying all information is complete and accurate, save the changes, download, print, or share the form as needed.

Ensure that you complete the Podiatry Referral Form online today to help ensure timely treatment for your patient.