Essential referral information Without this information the referral will be returned General referral information Details of relevant signs and symptoms including duration and frequency of episodes...
Essential referral information Without this information the referral will be rejected Medication history ELFTs, FBC, TSH results All available ECGs (including an ECG showing SVT if possible)
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...