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Referral Templates and Pre-Referral Guidelines

Referral to St Vincent’s

The referral templates and pre-referral guidelines page will give you you all the guidance you need when making a referral to St Vincent's Hospital.

Click here for instructions on how to import templates into GP clinical software:
Best Practice, Medical Director, Genie, ZedMed.


Referral Templates for Specialist Clinics:


Please address all referrals to Dermatology Clinic to a named specialist - A/Prof Chris Baker (Head of Clinic)


Endoscopy Referral Templates for Gastroenterology / Colorectal / Upper Gastrointestinal Surgery Clinics:

Referrals for patients likely to require endoscopy must be made using the templates below:

Please visit Endoscopy website for further information


Referral Templates for Hepatitis C Treatment Request:



Referrals to St Vincent's Heart Centre: 

Please FAX a referral form or letter to: (03) 9231 3333

For any enquiries please contact Heart Centre reception on Tel: (03) 9231 3000

or phone: 9231 5827 (GP direct access)




Referrals to Cancer Centre: 

Please FAX a referral letter to: (03) 9231 3172

For any enquiries please contact Cancer Centre reception on Tel: (03) 9231 3155




Referrals to Palliative Care:

Please FAX a referral letter to: (03) 9231 4143

For more information on palliative care outpatient appointments Tel: (03) 9231 2827




Referrals to Barbara Walker Centre for Pain Management:

Pain Management Referral Form and Guidelines

Please FAX referral form to: (03) 9231 4660

For enquiries, please phone: (03) 9231 4681


Referrals to Community Osteoarthritis Knee Clinic:

Referral Guidelines

Please FAX referral form to: (03) 9231 1072

For enquiries, please phone: (03) 9387 6711


Referrals to Breast Clinic:

Breast Clinic Referral Guidelines

Please FAX referral form to: (03) 9231 2017

For enquiries, please phone: (03) 9231 4743


Obesity Management Clinic:

  • Please FAX referrals to: (03) 9231 3590
  • Referral criteria: BMI > 35kg/m2 with medical co-morbidities that will improve with weight loss

Referral Templates for Aged Care and Community Services:

This referral template is for the following services:

  • Aged Psychiatry Assessment and Treatment Team (APATT)
  • Community Rehabilitation Centres
  • HARP (Hospital Admission Risk Program)
  • Home-Based Allied Health
  • Polio Services Victoria
  • Young Adults Complex Disability Service
  • Specialist Clinics - Continence Clinic, Cognitive Dementia and Memory Clinic, Geriatric Medical Clinic, Falls and Balance Clinic, Pain Clinic for Older Persons


Referral Template for inter-hospital referral to Sub Acute Ambulatory Care Services (SACS):

Please Note: This referral form is for inter-hospital use only and not for referrals from General Practice

This referral template is for the following services:

  • Geriatric Evaluation and Management (GEM)
  • Restorative Care
  • Day Respite
  • Rehabilitation

Diagnostic Services:


Patient Information Request:




Fibroscan Request:


Transport Request:

This form needs include the following information:

  • Please FAX this form to: 9231 4261 
  • Enquiries to phone: 9231 3480 (Patient Transport Officer)
  • Please ensure that all fields on this form are completed as forms not correctly filled in will not be able to be processed  
  • Forms must be signed by a Doctor or RN1
  • Please ensure patient’s phone number is included to confirm transport the day before 


Lithotripsy Service Referral:


Importing Referral Templates:

Instructions: Best Practice, Medical Director, Genie, ZedMed


Community Osteoarthritis Knee Clinic Referral Guidelines

The Community Osteoarthritis Knee Clinic is a community-based service that will assess and treat patients with osteoarthritis of the knee. The clinic offers patients a specialist osteoarthritis assessment and a collaborative approach to determining the best treatment options for the patient’s osteoarthritis. The clinic team includes an orthopaedic surgeon, rheumatologist, GP, advanced musculoskeletal physiotherapist and dietitian.

The clinic is run by St Vincent’s Hospital Melbourne in collaboration with Merri Health. The clinic is located at the Merri Health Community Health Service , 11 Glenlyon Rd, Brunswick.

Referral criteria

  • Patients from the North Western Melbourne area
  • 40 years of age or older at the time of the referral
  • Primary diagnosis of osteoarthritis knee

Referral requirements

  • X-ray within 6 months required: lateral knee, skyline patella and weight bearing AP knee
  • Refer to Professor Peter Choong, Community Osteoarthritis Knee Clinic

HealthPathways Melbourne is an online portal designed to be used by general practice at the point of care to guide best practice assessment, management and referral of common clinical conditions.