Referral Templates for Specialist Clinics:
Please address all referrals to Dermatology Clinic to a named specialist - A/Prof Chris Baker (Head of Clinic)
Endoscopy Referral Templates for Gastroenterology / Colorectal / Upper Gastrointestinal Surgery Clinics:
Referrals for patients likely to require endoscopy must be made using the templates below:
Please visit Endoscopy website for further information
Referral Templates for Hepatitis C Treatment Request:
Referrals to St Vincent's Heart Centre:
Please FAX a referral formor letter to: (03) 9231 3333 and the Heart Centre will contact your patient.
For any enquiries, please contact Heart Centre on Tel: (03) 9231 1399 (GP direct access)
Referrals to Cancer Centre:
Please FAX a referral letter to: (03) 9231 3172
For any enquiries please contact Cancer Centre reception on Tel: (03) 9231 3155
Referrals to Palliative Care:
Please FAX a referral letter to: (03) 9231 4143
For more information on palliative careoutpatient appointments Tel: (03) 9231 2827
Referrals to Barbara Walker Centre for Pain Management:
Pain Management Referral Form and Guidelines
Please FAX referral form to: (03) 9231 4660
For enquiries, please phone: (03) 9231 4681
Referrals to Breast Clinic:
Breast Clinic Referral Guidelines
Please FAX referral form to: (03) 9231 2017
For enquiries, please phone: (03) 9231 4743
For enquiries, please phone: (03) 9231 4743 Email: BreastNurseCoOrdinator@svha.org.au
Obesity Management Clinic:
- Please FAX referrals to: (03) 9231 3590
- >Referral criteria: BMI > 35kg/m2 with medical co-morbidities that will improve with weight loss
Referral Templates for Aged Care and Community Services:
This referral template is for the following services:
- Aged Psychiatry Assessment and Treatment Team (APATT)
- Community Rehabilitation Centres
- HARP (Hospital Admission Risk Program)
- Home-Based Allied Health
- Polio Services Victoria
- Young Adults Complex Disability Service
- Specialist Clinics - Continence Clinic, Cognitive Dementia and Memory Clinic, Geriatric Medical Clinic, Falls and Balance Clinic, Pain Clinic for Older Persons
Referral Template for inter-hospital referral to Sub Acute Ambulatory Care Services (SACS):
Please Note: This referral form is for inter-hospital use only and not for referrals from General Practice
Diagnostic Services:
Patient Information Request:
Pathology:
Fibroscan Request:
Transport Request:
This form needs include the following information:
- Please FAX this form to: 9231 4261
- Enquiries to phone: 9231 3480 (Patient Transport Officer)
- Please ensure that all fields on this form are completed as forms not correctly filled in will not be able to be processed
- Forms must be signed by a Doctor or RN1
- Please ensure patient’s phone number is included to confirm transport the day before
Lithotripsy Service Referral:
Importing Referral Templates:
Instructions: Best Practice, Medical Director, Genie, ZedMed