Essential referral information Without this information the referral will be returned Cholesterol/ triglyceride/ HDL-cholesterol/ LDL-cholesterol TSH, ELFT, CK, HbA1c
Essential referral information Without this information the referral will be returned History including family history of delayed puberty or hypogonadism. History of chronic ill health or any...
Essential referral information Without this information the referral will be returned History including menopausal status alcohol history fractures & medications glucocorticoid therapy early menopause...
Essential referral information Without this information the referral will be returned History of illness: (include details of symptoms of raised ICP, specific neurological deficits, seizures or visual...
Essential referral information Without this information the referral will be returned Details of all treatments offered and efficacy Duration of symptoms & associated symptoms Plans re pregnancy if...
Essential referral information Without this information the referral will be rejected Previous imaging or cytology TFTs – free T4, T3 and TSH USS, CXR results
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' hormone levels relevant...
Essential referral information Without this information the referral will be returned Approximate age at diagnosis Smoking Status Duration and severity of symptoms (breathlessness, chest tightness...
Essential referral information Without this information the referral will be returned History of the disease including duration, severity and frequency of exacerbations Management to date Medications...
Essential referral information Without this information the referral will be returned Symptoms Duration and severity Associated syncope, incontinence, SOB Relevant examination findings History of ENT...