Get Direct Access Choose Book Upper Gi Diagnostic Endoscopy Endoscopy - Referral Form

Filling out the Direct Access Choose Book Upper GI Diagnostic Endoscopy Endoscopy - Referral Form online is a straightforward process that helps facilitate necessary medical referrals. This guide provides clear steps to ensure that users can complete the form accurately and efficiently.

Follow the steps to successfully complete the referral form.

1. Click ‘Get Form’ button to access the form and open it for editing.
2. Begin by entering the GP details. Provide the GP's name, practice name, and address in the designated fields for accurate identification.
3. Input the patient details. Fill out the patient's title, forename, surname, address, postcode, daytime telephone number, date of birth, hospital number, and NHS number in the specified blocks.
4. Next, detail any additional contact information. Include the postcode, telephone number, fax number, and PCT code where required.
5. In the section titled 'Date', enter the current date to document when the referral is being made.
6. Indicate the reason for the Upper GI Endoscopy referral. Be sure to include relevant medical history for comprehensive context.
7. Review the criteria section to ensure that the patient does not fall under any exceptions listed for this form, including age limitations and medical conditions.
8. Confirm if the patient is fit for Gastroscopy by checking the relevant options regarding diabetic status, use of immunosuppressants, and usage. Include any notes if necessary.
9. Document any cardiac issues or relevant tests the patient has undergone, providing details where required.
10. Complete any required tests related to Helicobacter pylori, LFTs, Hb, WBC, Ferritin, and MCV, including the date they were taken.
11. Once all fields are filled, verify the information for accuracy, then save changes, download, print, or share the completed form as needed.

Start filling out your referral form online today for a seamless and efficient process.