If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

Falls

• Any fall occasioning serious trauma (including fractures, major soft tissue injury, head strike or concussion) that cannot be managed in primary care
• Frequent falls (more than one every few days)

Other

• Any condition defined by other CPCs as requiring referral to emergency

• A history of falls in the past year is the single most important risk factor for falls and is a predictor for further falls.
• Older people reporting a fall or considered at risk of falling should be observed for balance and gait deficits.  They should be considered for interventions that improve strength and balance.
• Consider referral to clinical pharmacist for Home Medical Review if evidence of polypharmacy.
• Consider referral to specialist falls clinic (if available) if patient has suffered multiple falls with no cause found.
• Depending on specialist availability, patients with falls can be referred to either general medicine or geriatric medicine.  In the setting of multiple geriatric syndromes, referral to geriatric medicine may be preferred.
• The following links to cognitive assessment tools may be useful:
  • General screening information: https://health.dementia.org.au/information/for-health-professionals/clinical-resources/cognitive-screening-and-assessment
  • Montreal Cognitive Assessment (MOCA):  http://dementiakt.com.au/doms/domains/cognition/moca
  • GP assessment of cognition (GPCOG) tool: http://gpcog.com.au/
  • Standardised mini-mental state examination (MMSE):  https://www.ihpa.gov.au/sites/g/files/net636/f/publications/smmse-tool-v2.pdf
• Evidence for fall prevention strategies:
  • exercise
  • high dose vitamin D
  • psychoactive medication withdrawal (particularly antidepressants, antipsychotics and benzodiazepines)
  • occupational therapy home visit
  • restricted multifocal spectacle use
  • expedited cataract surgery (where required)
  • podiatry assessment and intervention
  • multifactorial assessment with targeted interventions (including referral to physiotherapist, occupational therapist and/or dietitian as appropriate).

Does your patient meet the minimum referral criteria?

If your patient does not meet the minimum referral criteria

• Consider other treatment pathways or an alternative diagnosis
• If you still need to refer your patient:
  • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Patient's Demographic Details

• Full name (including aliases)
• Date and country of birth
• Residential and postal address including whether patient resides at an aged care facility
• Telephone contact number/s – home, mobile and alternative
• Medicare number (where eligible)
• Name of the parent or caregiver (if appropriate)
• Name of delegate and contact details (Department of Corrective Services)
• Preferred language and interpreter requirements
• Identifies as Aboriginal and/or Torres Strait Islander
• Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

• Full name
• Full address
• Contact details – telephone, fax, email
• Provider number
• Date of referral
• Signature
• Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Relevant clinical information about the condition

• Presenting symptoms (evolution and duration)
• Physical findings
• Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
• All conservative options that have been pursued unsuccessfully prior to referral
• Body mass index (BMI)
• Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
• Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
• Current medications and dosages
• Drug allergies
• Alcohol, tobacco and other drugs use

Reason for request

• To establish a diagnosis
• For treatment or intervention
• For advice and management
• For specialist to take over management
• Reassurance for GP/second opinion
• For a specified test/investigation the GP can't order, or the patient can't afford or access
• Reassurance for the patient/family
• For other reason (e.g. rapidly accelerating disease progression)
• Clinical judgement indicates a referral for specialist review is necessary

Clinical modifiers

• Impact on employment
• Impact on education
• Impact on home
• Impact on activities of daily living functioning – low/medium/high
• Impact on ability to care for others
• Impact on personal frailty or safety
• Identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

• Willingness to have surgery (where surgery is a likely intervention)
• Choice to be treated as a public or private patient
• Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc