Get the free Specialist Palliative Care Referral Form - Guy's and St Thomas'

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. Start by gathering all necessary information about the patient, including their full name, date of birth, contact information, and current medical condition.
2. Specify the reason for the referral, providing details about the patient's diagnosis, symptoms, and any previous treatments they have undergone.
3. Include relevant medical history, such as previous illnesses, surgeries, or ongoing medications.
4. Ensure that the referral includes a concise but comprehensive summary of the patient's current condition, including any physical, emotional, or psychological symptoms they may be experiencing.
5. If applicable, include information about the patient's support system, such as family members or caregivers, and their involvement in the patient's care.
6. It is important to provide any relevant test results, imaging scans, or laboratory reports that support the need for specialist palliative care.
7. If the patient has any specific preferences or goals related to their care, ensure that these are clearly communicated in the referral.
8. Include the name and contact information of the referring healthcare professional, as well as any relevant healthcare organization details.
9. Double-check for accuracy and completeness before submitting the referral.

Who needs specialist palliative care referral:

1. Patients who have been diagnosed with a life-limiting illness, such as advanced cancer, end-stage heart failure, or chronic obstructive pulmonary disease (COPD), may require specialist palliative care referral.
2. Individuals experiencing severe and uncontrolled physical symptoms, such as pain, nausea, or breathlessness, that significantly affect their quality of life may benefit from a specialist palliative care referral.
3. Patients with complex psychosocial or emotional needs, including those struggling with anxiety, depression, or existential distress, may require the expertise of a palliative care team.
4. Individuals who require assistance in advanced care planning, including discussions about goals of care, treatment options, and end-of-life preferences, may benefit from a referral to specialist palliative care.
5. Family members or caregivers who require support in managing the physical, emotional, or practical challenges associated with caring for a loved one with a life-limiting illness may also benefit from a specialist palliative care referral.

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What is specialist palliative care referral?

Specialist palliative care referral is the process of referring a patient with a serious illness to a specialized 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 physicians, nurses, or social workers, are required to file specialist palliative care referral.

How to fill out specialist palliative care referral?

To fill out a specialist palliative care referral, healthcare providers need to gather the patient's medical information, including diagnosis and current symptoms, and submit the referral to the palliative care team.

What is the purpose of specialist palliative care referral?

The purpose of specialist palliative care referral is to improve the quality of life for patients with serious illnesses by providing specialized care to manage symptoms and address psychosocial needs.

What information must be reported on specialist palliative care referral?

Information such as the patient's diagnosis, current symptoms, medical history, and any specific goals or preferences for care must be reported on a specialist palliative care referral.