PAEDIATRIC RAPID REFERRAL CLINIC REFERRAL FORM
Please see referral guidance overleaf for further information
PATIENT DETAILS
First name: Surname: DOB:
NHS Number:
Hospital number (if known):
Address:
Contact Telephone Number (MUST BE PROVIDED):
REFERRER DETAILS
Name:
G.P Practice/Address:
Contact Telephone Number:
Fax Number/ Email Address :
REASON FOR REFERRAL Date : Time:
Referral received:
Date: Time: / Referral triaged:
Date: Time: / Triage instructions: / Appointment offered:
Date: Time:
REFERRAL GUIDANCE
Service Description: The Rapid Referral Clinic is a rapid access general paediatric outpatient clinic for children aged 0-16 years who require an urgent paediatric specialist opinion within 4 weeks. It is for children who are not unwell enough to require same day attendance at the emergency department, but who cannot wait more than 4 weeks for a routine outpatient appointment.
Venue : Dragon Children’s Centre, Lanesborough wing, St George’s Hospital, Blackshaw Road, Tooting, London SW17 0QT
Time: Tuesdays and Wednesdays 13.30 to 16.00
Referral procedure: GPs to complete this form and fax or email it to the St George’s CDC admin team.
FAX NUMBER : 0208 725 0311
EMAIL ADDRESS:
TELEPHONE NUMBER FOR QUERIES: 0208 725 1896
Inclusion criteria: Children who need a senior paediatric opinion within 4 weeks but are unlikely to need admission.
Exclusion criteria : Children who require routine outpatient services or who are known to a specialist team with the same problem. Referrals will be re-directed if appropriate, eg children with seizures go to the Epilepsy Clinic. Those who are seriously unwell and likely to need immediate treatment or hospital admission should be discussed with the paediatric registrar on bleep 7474 and sent to A&E.
Appointment procedure: All referrals will be triaged by a consultant every week day. If a rapid referral clinic appointment is indicated the parents will be contacted to offer them an appointment. We aim to see all referrals within 4 weeks.
Outcome Clinic Letter: We aim to send a clinic letter to GPs and parents within 10 days.
Responsible consultants: Dr Sarah Thurlbeck and Dr Luci Etheridge, consultant paediatricians