If the Patient needs to be seen in the next 48hrs, send Patient to Emergency Department or please contact Acute care teams (ACT) on Phone 1300 MH CALL (1300 64 22 55) (24 hour)
Emergency
Standard Referral Information
Patient's Demographic Details
- Full name (including aliases)
- Date and country of birth
- Residential and postal address including whether patient resides at an aged care facility
- Telephone contact number/s – home, mobile and alternative
- Medicare number (where eligible)
- Substitute decision maker/carer
- Preferred language and interpreter requirements
- Identifies as Aboriginal and/or Torres Strait Islander
- Any special needs, access requirements and/or disability relevant to the referral
Referring Practitioner Details
- Full name
- Full address
- Contact details – telephone, fax, email
- Provider number
- Date of referral
- Signature
- Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner
Relevant clinical information about the condition
- Presenting symptoms (evolution and duration)
- Physical findings
- Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
- All conservative options that have been pursued unsuccessfully prior to referral
- Body mass index (BMI)
- Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
- Any special care requirements where relevant (e.g. tracheostomy in place, oxygen required)
- Current medications and dosages
- Drug allergies
- Alcohol, tobacco and other drugs use
Reason for request
- To establish a diagnosis
- For treatment or intervention
- For advice and management
- For specialist to take over management
- Reassurance for GP/second opinion
- For a specified test/investigation the GP can't order, or the patient can't afford or access
- Reassurance for the patient/family
- For other reason (e.g. rapidly accelerating disease progression)
- Clinical judgement indicates a referral for specialist review is necessary
Minimum referral criteria
The Older Persons Mental Health Service provide outpatient services to clients over the age of 65 and ATSI clients over the age of 55 with a suspected or diagnosed mental illness. The service also operates a psychogeriatric neurocognitive assessment clinic (memory clinic for those clients with suspected or diagnosed cognitive impairment as well as a mental illness).
Essential referral information
This is not a CPC guideline. West Moreton staff please select 'CPC not applicable'
- General referral information
- FBC/ELFT's, Ca/Mg/P04, b12 and Folate, Lipid Profile, Thyroid Function Test
- Syphilis Serology, HIV status, Hepatitis status if clinically indicated
- MSU
- CXR, CT scans, MRI if available and clinically indicated
- Name and contact details of carer
- Current living arrangements
- Home access issues
- Community services currently in place
- Any recent Non-Queensland health discharge summaries
- For all psychogeriatric neurocognitive clinic referrals complete MMSE
To request a psychogeriatric review please complete Older persons mental health referral form.
For psychogeriatric neurocognitive assessment please complete referral form.
Out of catchment
West Moreton Health is responsible for providing a public health service to people who reside within its catchment area. To appropriately manage demand for service we do not accept referrals from outside this catchment area. If your patient does live outside the West Moreton Health area and it is deemed socially or clinically necessary for their care to be received in the West Moreton Health Service, inclusion of information regarding their particular medical and/or social factors will assist with the triaging of your referral.
Feedback
To provide feedback about contents on this website or general referral questions please email WM-CPC@health.qld.gov.au or phone 3413 7402.