Get the free Specialist Palliative Care Referral Form - St Christopher's Hospice - stchristop...

Specialist Palliative Care Referral Form South London Palliative and Supportive Care Network Ellen or Foundation (North Bella) Tel: 020 8310 4100 Fax: 020 8312 2115 Guy s and St Thomas Guy s Site:

How to fill out specialist palliative care referral

How to fill out specialist palliative care referral:

1. Begin by accessing the necessary referral form. This can usually be obtained from the healthcare facility or organization involved in providing palliative care services.
2. Start by providing the patient's personal information, including their name, date of birth, contact details, and any relevant identification numbers. This ensures accurate identification and communication.
3. Document the patient's medical history and current condition. Include information about the primary diagnosis, any relevant comorbidities, and notable symptom management issues.
4. Specify the reason for the referral and the desired outcome. Detail the specific palliative care needs that the patient requires, such as pain management, psychosocial support, or end-of-life care.
5. Include relevant test results, diagnostic reports, or medical records that support the need for specialist palliative care. This helps ensure a comprehensive understanding of the patient's condition and any previous treatments.
6. Indicate any preferences or special instructions regarding the referral. This may include requesting a particular healthcare provider, specifying any religious or cultural considerations, or outlining specific goals of care.
7. Sign and date the referral form, providing contact information for the referring healthcare professional.

Who needs specialist palliative care referral:

1. Patients with advanced or life-threatening illnesses who require specialized support for symptom management, psychosocial care, and optimizing their quality of life.
2. Individuals experiencing debilitating physical symptoms such as uncontrolled pain, nausea, breathlessness, or severe fatigue, which are challenging to manage using standard treatment approaches.
3. Patients struggling with emotional or psychological distress, such as anxiety, depression, fear, or existential concerns, related to their illness or prognosis.
4. Individuals requiring support for complex decision-making, advance care planning, or navigating ethical considerations surrounding end-of-life care.
5. Patients and families who would benefit from expert guidance and holistic care addressing their psychosocial, spiritual, and cultural needs.
6. Individuals in need of interdisciplinary care involving a team of healthcare professionals, including physicians, nurses, social workers, chaplains, and other specialists, who collaborate to provide comprehensive palliative care.

It is essential to consult with healthcare professionals or refer to specific guidelines in your region to ensure accurate completion of a specialist palliative care referral, as requirements may vary.

For pdfFiller’s FAQs

What is specialist palliative care referral?

Specialist palliative care referral is a process where a healthcare provider refers a patient with a life-limiting illness to a specialist team that focuses on providing relief from the symptoms and stress of the illness.

Who is required to file specialist palliative care referral?

Healthcare providers such as doctors, nurses, and social workers are required to file specialist palliative care referral for patients with life-limiting illnesses.

How to fill out specialist palliative care referral?

To fill out a specialist palliative care referral, healthcare providers need to gather relevant patient information, complete the referral form, and submit it to the specialist palliative care team.

What is the purpose of specialist palliative care referral?

The purpose of specialist palliative care referral is to ensure that patients with life-limiting illnesses receive specialized care and support to alleviate their symptoms and improve their quality of life.

What information must be reported on specialist palliative care referral?

Information such as patient demographics, medical history, current symptoms, and treatment goals must be reported on specialist palliative care referral.

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