Get the free Lymphoedema Referral Form - pwh.org.uk

Lymphedema Referral Form Please return to medical fax number 01977 600097 or forward in the post Date of Referral:Name of Patient:Name of Referrer:NHS No:Title of Referrer:Address:Referrers Practice: Referrers

How to fill out lymphoedema referral form

How to fill out lymphoedema referral form

1. To fill out the lymphoedema referral form, follow these steps:
2. - Begin by obtaining a copy of the form from the relevant healthcare provider or facility.
3. - Fill in your personal information, including your name, address, date of birth, and contact details.
4. - Provide details about your medical history, including any underlying conditions or previous surgeries.
5. - Indicate the reason for the referral and the specific symptoms or issues related to lymphoedema.
6. - If applicable, include information about your current treatment plan and any medications you are taking.
7. - Be thorough in describing your symptoms and their impact on your daily life.
8. - If you have any relevant medical records or test results, attach copies to the form.
9. - Once completed, review the form to ensure all required fields are filled in accurately.
10. - Submit the form to the designated healthcare provider or facility as instructed.

Who needs lymphoedema referral form?

1. Anyone who suspects they may have lymphoedema or has been diagnosed with lymphoedema may need to fill out a lymphoedema referral form.
2. This could include individuals experiencing symptoms such as swelling, pain, heaviness, or restricted movement in certain body parts.
3. Additionally, healthcare providers or professionals who are referring patients for lymphoedema assessment or treatment may also need to complete this form.

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What is lymphoedema referral form?

The lymphoedema referral form is a document used to refer a patient to a specialist for evaluation and treatment of lymphoedema.

Who is required to file lymphoedema referral form?

Healthcare providers, such as doctors, nurses, and therapists, are required to file the lymphoedema referral form.

How to fill out lymphoedema referral form?

The lymphoedema referral form can be filled out by providing the patient's personal information, medical history, symptoms, and any relevant test results.

What is the purpose of lymphoedema referral form?

The purpose of the lymphoedema referral form is to ensure that patients with lymphoedema receive appropriate care and treatment from specialists.

What information must be reported on lymphoedema referral form?

The lymphoedema referral form must include the patient's name, date of birth, contact information, medical history related to lymphoedema, and any relevant test results.