- Refer to ENT CPC, Health pathways or local guidelines
- Concurrent referral to ENT is Recommend
- Patient education/tinnitus management advice
- Chronic tinnitus consider:
– private audiology for tinnitus retraining therapy, masking hearing aid or for hearing aid if hearing loss present
– referral to psychologist due to possible links with stress, anxiety and depression
– referral to hearing practitioner as management of associated hearing loss can sometimes help with tinnitus.
– public/private audiology for patient education/tinnitus management advice - Unilateral tinnitus may require investigation for retro cochlear lesion; consider Imaging for investigation of retro cochlear lesion (Health Monash, 2014)
- Consider referral to a Dentist &/or Physiotherapist if associated TMJ problems are suspected
Clinical resources
- ENT CPC
- Tinnitus Questionnaire
Patient resources
- Tinnitus Australia
- Tinnitus Reaction Questionnaire (TRQ)
Does your patient meet the minimum referral criteria?
Category 1 (appointment within 30 calendar days) |
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Category 2 (appointment within 90 calendar days) |
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Category 3 (appointment within 365 calendar days) |
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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
Essential referral information
Without this information the referral will be returned
- History including relevant symptoms, comorbidities, cognitive ability, physical mobility and dexterity (NICE Guidelines, 2018)
- Description of:
– hearing loss i.e. one or both sides
– change in hearing loss (sudden, rapid or gradual)
– failed screening results
– describe symptoms that are persistent and/or troublesome to patient or family
- Mechanism of injury (barotrauma)
- Psychological history
- Documented social modifiers on quality of life
- Documented TMJ or recent dental work (dental/Physiotherapist as necessary)
- Any intervention and its effect
Out of catchment
West Moreton Health is responsible for providing a public health service to people who reside within its catchment area. To appropriately manage demand for service we do not accept referrals from outside this catchment area. If your patient does live outside the West Moreton Health area and it is deemed socially or clinically necessary for their care to be received in the West Moreton Health Service, inclusion of information regarding their particular medical and/or social factors will assist with the triaging of your referral.
Feedback
To provide feedback about contents on this website or general referral questions please email WM-CPC@health.qld.gov.au or phone 3413 7402.