Get the free TISSUE VIABILITY SERVICE REFERRAL FORM - ntwnhsuk

Appendix 2 Northumberland, Type and War NHS Foundation Trust 1 Appendix 2 Tissue Viability Service Referral Form V01 Issue 1 Issued April 2015

How to fill out tissue viability service referral

How to fill out a tissue viability service referral:

1. Start by obtaining the appropriate referral form from the tissue viability service provider or healthcare facility.
2. Fill in the patient's personal information accurately, including their full name, date of birth, address, and contact details.
3. Provide relevant medical information about the patient, such as their medical history, current diagnoses, and any ongoing treatment or medications.
4. Indicate the reason for the referral, specifying the tissue viability concern or problem that requires assessment and management.
5. Include any relevant supporting documentation or test results to assist the tissue viability team in evaluating the patient's condition.
6. If applicable, provide details of any wound care products or treatments that have been previously used and their effectiveness.
7. Specify any specific goals or outcomes desired from the tissue viability service, such as wound healing, pain management, or prevention of further tissue damage.
8. If available, attach photographs of the wound or affected area for a more comprehensive evaluation.
9. Ensure clear and legible handwriting or use electronic referral systems to avoid any misinterpretation of information.
10. Review the completed referral form for accuracy and completeness before submitting it to the tissue viability service provider.

Who needs tissue viability service referral?

1. Patients with complex or chronic wounds that are not healing or have the potential for delayed healing.
2. Individuals with tissue damage caused by pressure ulcers, diabetic ulcers, venous ulcers, arterial ulcers, or other conditions affecting skin integrity.
3. Patients with compromised tissue viability due to medical conditions, surgery, trauma, or prolonged immobility.
4. Healthcare professionals seeking specialized advice or expertise in managing wounds, pressure relief, or prevention of tissue damage.
5. Caregivers or family members concerned about a loved one's skin integrity or wound management and require professional assistance.
6. Individuals with conditions that put them at risk of developing wounds, such as diabetes, peripheral arterial disease, or spinal cord injuries.
7. Long-term care facility residents or individuals receiving home healthcare services who require ongoing wound care.
8. Patients with potential problems related to skin or tissue viability that may require further evaluation and intervention.

Note: This answer provides general information and may vary depending on the healthcare system and specific tissue viability service provider. It is important to consult with healthcare professionals or follow local guidelines for accurate and detailed referral processes.

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What is tissue viability service referral?

Tissue viability service referral is a process where healthcare professionals refer patients to specialist services for assessment and management of wounds, skin conditions, and tissue damage.

Who is required to file tissue viability service referral?

Healthcare professionals such as nurses, doctors, and therapists are required to file tissue viability service referral.

How to fill out tissue viability service referral?

Tissue viability service referral can be filled out by providing patient information, wound assessment, treatment history, and reason for referral.

What is the purpose of tissue viability service referral?

The purpose of tissue viability service referral is to ensure that patients receive appropriate and timely care for their wounds and tissue damage.

What information must be reported on tissue viability service referral?

Information such as patient demographics, wound characteristics, treatment plan, and healthcare provider details must be reported on tissue viability service referral.