Essential referral information Without this information the referral will be returned Details of all treatments offered and efficacy Relevant medical history Description of syncopal/pre-syncopal...
Essential referral information Without this information the referral will be returned This is not a CPC guideline. West Moreton staff please select 'CPC not applicable' Signs and symptoms of disease...
Essential referral information Without this information the referral will be returned History of Any abnormal bleeding (i.e. post –coital and intermenstrual) Unexplained persistent deep dyspareunia or...
Essential referral information Without this information the referral will be returned General referral information Findings of speculum examination Current cervical screening Pelvic USS (TVS...
Essential referral information Without this information the referral will be returned General referral information History of: nature of the pain – location, intermittent or persistent general body...
Essential referral information Without this information the referral will be returned General referral information History of: symptoms Heavy Menstrual Bleeding (HMB), brief description of periods...
Essential referral information Without this information the referral will be returned General referral information Brief description of periods Medical management to date Current cervical screening...
Essential referral information Without this information the referral will be returned History of: previous pregnancies, STIs and PID, surgery, endometriosis other medical conditions Include the...
Essential referral information Without this information the referral will be returned History of abnormal bleeding / hormonal contraceptive use Recent co-test result (HPV and LBC) HVS result BHCG...
Essential referral information Without this information the referral will be returned General referral information Medical management to date/surgical history History of pain and menstrual diary...