Get Exercise Referral Transfer Form - Vale Of York Ccg - Valeofyorkccg Nhs

The Exercise Referral Transfer Form is an essential document used to refer patients to appropriate physical activity schemes. This guide provides clear, step-by-step instructions on how to complete this form online to ensure that all necessary information is provided.

Follow the steps to successfully complete the Exercise Referral Transfer Form.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. In the ‘Patient Details’ section, enter the patient's full name, gender, ethnicity, date of birth, address, and postcode.
3. Specify the reason for referral by checking the relevant medical conditions against the scheme criteria, including options like hypertension, obesity, and depression.
4. Complete the ‘Baseline Measurements’ section by providing resting systolic and diastolic blood pressure, heart rate, and BMI.
5. Detail any relevant medical conditions under the ‘Medical Conditions’ section, including both current and past health issues.
6. List any medications the patient is currently taking in the ‘Medication’ section.
7. Describe any physical limitations the patient may have in the ‘Physical Limitations’ section.
8. Include any additional relevant information that has not been covered in the previous sections in the ‘Additional Relevant Information’ section.
9. In the ‘Authorisation’ section, the referring practitioner should confirm the accuracy of the information provided, add their name, signature, contact number, and the date of referral.
10. The patient must complete the ‘Patient Consent’ section by printing their name, signing, and dating the form.
11. Ensure that all sections of the form are completed accurately, then save changes, download, print, or share the form accordingly.

Complete your Exercise Referral Transfer Form online to ensure a smooth referral process.