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)


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

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

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):

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:

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



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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.