Get Patient Referral Form For Specialist ... - Trinity Hospice
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How to fill out the PATIENT REFERRAL FORM FOR SPECIALIST PALLIATIVE CARE - Trinity Hospice online
Filling out the Patient Referral Form is an essential step in ensuring that individuals receive the specialist palliative care they need. This guide provides clear instructions on how to accurately complete the form online, facilitating a seamless referral process.
Follow the steps to complete your referral form:
- Press the ‘Get Form’ button to access the referral form and open it in your preferred document management software.
- Begin by entering the patient details. Fill in the patient's name, any known aliases, date of birth, contact information, and address. Indicate whether the patient is currently at home or in a hospital, including ward information if applicable.
- Ensure that the patient and their family are informed and consent to the referral. Mark 'Yes' or 'No' where prompted regarding the patient's awareness and family agreement.
- Fill in the details of the main carer or next of kin. Include their name, relationship to the patient, and contact information if necessary.
- Provide the patient's diagnosis, including life-limiting conditions, date of diagnosis, and outcomes of any previous treatment along with planned future treatment intentions.
- List the current problems that require specialist palliative care and select the reason for referral, such as end-of-life care, pain management, or emotional support.
- Complete the section regarding advance care planning by stating if the patient has an advance care plan document and the preferred place of care. Also, indicate their status on the Gold Standards Framework Register.
- Include the general practitioner (GP) details: their name, surgery address, and confirm if they are aware of the referral. Also, mention if the district nursing team is involved.
- List other professionals involved in the patient’s care, providing their names and contact numbers as necessary.
- Finally, the referrer must print their name, job designation, contact number, and either sign or provide their email address to validate the form. Ensure that the current medication list and relevant clinic letters are attached.
- Review the completed form for accuracy, and then save your changes. You can choose to download, print, or share the form as required.
Start the referral process now by filling out the form online!
Trinity Health's patient portal is a secure online platform that allows patients to access their health information and communicate with their healthcare providers. Through the portal, patients can view their medical records, schedule appointments, and manage their care more efficiently. Additionally, it provides easy access to the PATIENT REFERRAL FORM FOR SPECIALIST ... - Trinity Hospice, making it simple for patients and families to initiate referrals.