Referral Templates and Pre-Referral Guidelines

Referral to St Vincent’s (all referrals must be faxed)

The referral templates and pre-referral guidelines page will give you you all the guidance you need when making a referral to St Vincent's Hospital.

Click here for instructions on how to import templates into GP clinical software:
Best Practice, Medical Director, Genie, ZedMed.

Specialist Clinics Referral Forms

Referral Templates for Specialist Clinics:

Please address all referrals to Dermatology Clinic to a named specialist - A/Prof Chris Baker (Head of Clinic)

Neurosurgery Referrals for Specialist Clinics:

Please refer to the Neurosurgery Referral Guidelines for further information.

Please see here for Exclusion Criteria.

Spinal Assessment and Management Service Referral Form -
As of the 23rd September 2019, all spinal referral will require this form.

Oro Maxillo Facial Referrals

The Maxillofacial Surgery Unit provides a complete range of specialist oral and maxillofacial surgical care for patients with facial trauma, benign and malignant oral pathology, facial deformity, and TMJ disorders.

We are not able to offer tooth extractions (including wisdom teeth) or other dental procedures under general anaesthetic except in the setting of patients with significant medical co-morbidities.

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 form or 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 care outpatient 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 Email: BreastNurseCoOrdinator@svha.org.au

Referrals to Lymphoedema Service:

Lymphoedema Service referral form

Please FAX referral form to: (03) 9231 3489

For enquiries/urgent referrals, please phone: (03) 9231 1971 (Tuesdays & Wednesdays)

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

Aged Care and Community Services Referral Forms

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):

Health Independence Programs Referral Form

Please Note: This referral form is for inter-hospital use only and not for referrals from General Practice

Community Sub Acute Admission Referral Forms

This referral template is for the following services:

Geriatric Evaluation and Management (GEM)
Restorative Care
Day Respite
Rehabilitation

Pre-Referral Guidelines

Useful Forms

Diagnostic Services:

Diagnostic Services Forms

Patient Information Request:

Patient Information Request Form

Pathology:

St Vincent's Pathology Request
St Vincent's Pathology Request (Lab copy)

Fibroscan Request:

Transport Request:

Specialist Clinics Patient Transport Request Form

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:

ESWL Referral Form
FAX: 9231 3627
Phone: 9231 3628
For more information visit the Lithotripsy webpage

Importing Referral Templates:

Instructions: Best Practice, Medical Director, Genie, ZedMed

HealthPathways Melbourne is an online portal designed to be used by general practice at the point of care to guide best practice assessment, management and referral of common clinical conditions.