REFERRAL FORMS

Here you will find some of the referral forms for various services We will continue to populate this over time

ANTENATAL

ANTENATAL BOOKING FORMS

For EMIS PCS practices: Click on the links below to download:

For EMIS LV practices:

For INPS Practices:

ANTENATAL BOOKINGS VIA EMAIL!

  • To support the early booking of your patients, please ensure you use the AnteNatal booking referral form relevant to your practice GP Clinical System with the mail-merge function.
  • All sections of the standard referral form need to be completed and easily readable – the LMP is very important so the Homerton can fast-track late bookers
  • Send forms to the Homerton as soon as the woman has been seen by the GP so Homerton have the maximum time to book them.
  • If a woman is given a booking by the GP to see the midwife at the surgery ensuring this appt is within 12 weeks and 6 days. If this is not possible please request for an appointment to be made elsewhere (e.g.Children's Centre)for the initial booking appointment.
  • The central Homerton email address to which all Antenatal booking forms can be emailed securely as an attachment (with an acknowledgement of receipt from the Homerton) to help streamline and speed up the referral process. This is homerton.antenatal@nhs.net
  • The AN referral documents come in two EMIS versions and one INPS or FAX version depending on the route you want your referrals to take in future.

WHAT YOU NEED TO DO: You need to choose as a practice how you want to send AN referrals and ensure the same route is being used by all referring clinicians within your practice team so the Homerton know which referral route your practice will be following.

  • Option 1: You can print out and manually complete the AN Referral Form FAX version above and FAX this to the following number: 020 8510 5727. This referral will be picked up by the Homerton in the usual way.
  • Option 2:Alternatively use the EMIS PCS or EMIS LV documents above which are set up with fields to merge in patient demographic / clinical information from the patient's record and AN Booking Template entries. These can be emailed to the Homerton directly to homerton.antenatal@nhs.net
  • NB:VERY IMPORTANT: Please note for patient confidentiality these referral emails MUST ONLY EVER BE SENT from an approved nhs.net email address and never from a personal email address (e.g. sending this from for instance joe.brown@nhs.net would be secure but NOT from joe.brown@hotmail.com or joe@googlemail.co.uk etc as this would not be a secure route for patient identifiable information and would therefore represent a breach of NHS patient confidentiality.

Hyperemesis Referral Form

Antenatal Referral to Liver Clinic

Referral Form

Please use this form to refer patients: AN referral form to Liver Clinic.doc

ISLINGTON RESIDENTS

PLEASE NOTE YOU REFER DIRECT TO ISLINGTON SERVICES FOR ISLINGTON RESIDENTS