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...
Essential referral information Without this information the referral will be returned Duration and severity of symptoms including impact on ADLs Current and previous treatment and efficacy...
Essential referral information Without this information the referral will be returned Comorbidities Medication list (particularly anticoagulants) Recent clinical events (particularly viral symptoms...
Essential referral information Without this information the referral will be returned Duration and severity of ILD or symptoms Management to date Other relevant medical conditions (particularly...
Essential referral information Without this information the referral will be returned Past medical history Current medications Previous cancer history including non-lung cancer treatment Relevant...