Get Specialist-palliative-care-referral-form-2013 - Trinity Hospice - Healthcare Trinityhospice Co

Filling out the Specialist-Palliative-Care-Referral-Form-2013 is a crucial step in ensuring that patients receive the appropriate palliative care they need. This guide provides clear, step-by-step instructions for completing this form online, ensuring all necessary information is accurately captured.

Follow the steps to effectively complete the referral form.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by reviewing the referral criteria to ensure the patient's condition aligns with the requirements for specialist palliative care. This includes verifying that the patient has a progressive, life-limiting diagnosis and is adequately supported by their current care team.
3. Enter the patient's details in the designated fields. Specify if the patient is at home, their name, known as, and whether they live alone. Ensure to indicate if the patient and their family are aware of and agree to the referral.
4. Provide the patient's location if they are not at home, including their address, ward (if hospitalized), contact number, and date of birth. Also, input the NHS and hospital numbers if available.
5. Fill out the carer or next of kin details. Include the name of the main carer, their relationship to the patient, and contact details if applicable.
6. Document the GP and surgery details, confirming if the GP is aware of the referral and if the District Nurse team is involved.
7. Describe the diagnosis of current problems, including the life-limiting diagnosis, date of diagnosis, and any other relevant medical conditions.
8. Outline the summary of treatment to date and any future planned treatment, along with other relevant information such as psychological and social issues.
9. Complete the advance care planning section, noting if the patient is on the Gold Standards Framework Register and their preferred place of care.
10. List other professionals involved in the patient's care, including their names and contact numbers.
11. Clarify the reason for referral and the type of input or interventions requested from specialist palliative care. Include details of specific problems and supportive measures currently in place.
12. If there is an urgent need for input, include a note to contact the palliative care team directly as instructed.
13. Ensure to include copies of any relevant documents such as medication lists and clinic letters that will support the referral.
14. Fill in the referrer's details. This includes the name, designation, and signature or email address of the referrer, as well as their contact number and the date of referral.
15. Finalize the form by reviewing all entries for accuracy. Save the form, and once completed, download, print, or share it as necessary.

Start filling out the Specialist-Palliative-Care-Referral-Form-2013 online today to ensure timely referral and support for your patient.