Referral Templates and Pre-Referral Guidelines

Important Information for GPs

Referrals to St Vincent’s Hospital Melbourne Specialist Clinics

St Vincent’s Hospital Melbourne Specialist Clinics are accepting referrals including those seeking an opinion or advice on diagnosis and management.
Face to face, telehealth and telephone consultations are allocated as appropriate.
Please remind your patients to bring their current GP and practice contact details.

Please don't forget the excellent resources: Health Pathways and the Statewide Referral Criteria

Referral to St Vincent's (all referrals must be faxed)

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

In order to effectively triage referrals, please include the following essential information in your referral:

Patient's demographic info
Full name
Date of birth
Contact details and address
Medicare Number/Overseas patient health insurance status
Indigenous status
Interpreter requirements
Clinical information
Specialty and head of unit to whom patient is referred
Reason for referral
Management to date
Medical history
Relevant diagnostic results
Allergies
Current medications
Name of referring doctor including provider number, practice name and contact details

By having all relevant information, the triage teams will be able to determine the most appropriate service for your patient and arrange a timely appointment,

Click here for instructions on how to import templates into GP clinical software.

Specialist Clinics Referral Forms

Referral Templates for Specialist Clinics:

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

Neurosurgery Referrals for Specialist Clinics:

Please refer to the Neurosurgery Referral Guidelines for further information.

Please see here for Exclusion Criteria.

Oro Maxillo Facial Referrals

The Maxillofacial Surgery Unit provides a complete range of specialist oral and maxillofacial surgical care for patients with facial trauma, benign and malignant oral pathology, facial deformity, and TMJ disorders.

We are not able to offer tooth extractions (including wisdom teeth) or other dental procedures under general anaesthetic except in the setting of patients with significant medical co-morbidities.

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 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 Breast Clinic:

Breast Clinic Referral Guidelines

Please FAX referral form to: (03) 9231 2017

For enquiries, please phone: (03) 9231 4743 Email: BreastNurseCoOrdinator@svha.org.au

Referrals to Lymphoedema Service:

Lymphoedema Service referral form

Please FAX referral form to: (03) 9231 3489

For enquiries/urgent referrals, please phone: (03) 9231 1971 (Tuesdays & Wednesdays)

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

Addiction Medicine Referral Forms

Referrals to Addiction Medicine:

Please FAX a referral letter to: (03) 9231 2642

Referral information: https://www.svhm.org.au/our-services/departments-and-services/a/addiction-medicine/referral-information

For any enquiries please contact Addiction Medicine reception on Tel: (03) 9231 6940

Aged Care and Community Services Referral Forms

Referral Templates for Community and Aged Care 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 Health Independence Program (HIP):

St Vincent’s Hospital Melbourne (SVHM) Health Independence Programs (HIP) encompass the Subacute Ambulatory Care Services (SACS), Complex Care Services (CCS) previously known as HARP, Residential In Reach (RIR) and Post-Acute Care Services (PAC). HIP comprises many of the services that deliver health care to support the transition from hospital to the home or to prevent the need for a hospital presentation or stay. Clients can access these services directly from the community. HIP services are delivered in the community, in ambulatory settings and in people’s homes.

Health Independence Programs Referral Form

Barbara Walker Centre for Pain Management Referral Forms

Referrals to Barbara Walker Centre for Pain Management:

BWCPM-referral-guidelines-and-referral-form.pdf

Please FAX referral form to: (03) 9231 4660

For enquiries, please phone: (03) 9231 4681

Cancer Centre Referral Forms

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

Community Sub Acute Admission Referral Forms

This referral template is for the following services:

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

Heart Centre Referral Forms

Referrals to St Vincent's Heart Centre:

Please FAX a referral form or letter to: (03) 9231 3333 and the Heart Centre will contact your patient.

For any enquiries, please contact Heart Centre on Tel: (03) 9231 1399 (GP direct access)

Pre-Referral Guidelines

Useful Forms

Diagnostic Services:

Diagnostic Services Forms

Patient Information Request:

Patient Information Request Form

Pathology:

St Vincent's Pathology Request
St Vincent's Pathology Request (Lab copy)

Fibroscan Request:

Transport Request:

Specialist Clinics Patient Transport Request Form

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:

ESWL Referral Form
FAX: 9231 3627
Phone: 9231 3628
For more information visit the Lithotripsy webpage

Importing Referral Templates:

Instructions: Best Practice, Medical Director, Genie, ZedMed

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.