BARWON HEALTH EMERGENCY DEPARTMENT REFERRAL 	- FAX 03 4215 0214
								- DUTY ED CONSULTANT 03 4215 0136

GP Referral
		Referral Date: <<Miscellaneous:Date (long)>>

Feedback Requested:  Yes	

	NB. Inpatient consultant or registrar needs to be contacted about ED referral			Referring General Practitioner:
<<Doctor:Name>> 
<<Practice:Name>>
<<Practice:Address>>
Phone: <<Practice:Phone>>   Fax: <<Practice:Fax>>
Email: <<Doctor:E-mail>>
Provider No.: <<Doctor:Provider Number>>

Consumer details:
Name:	<<Patient Demographics:First Name>> <<Patient Demographics:Surname>>
Date of Birth:	<<Patient Demographics:DOB>>
Age:                        <<Patient Demographics:Age>>
Preferred Name/s:	<<Patient Demographics:Greeting>>
Sex:	<<Patient Demographics:Sex>>
Title:	<<Patient Demographics:Title>>
ATSI:  <<Patient Demographics:ATSI>>
		Contact Address:	<<Patient Demographics:Full Name>>
	<<Patient Demographics:Address>>
	<<Patient Demographics:City>>  <<Patient Demographics:State>>    <<Patient Demographics:Postcode>>
Phone:	<<Patient Demographics:Phone (Home)>>
Work:	<<Patient Demographics:Phone (Work)>>
Mobile:	<<Patient Demographics:Phone (Mobile)>>
Email:	<<Patient Demographics:E-mail>>

 
Interpreter required: <<Does the patient require an interpreter?>>		DVA Number: <<Patient Demographics:DVA Number>>	
Preferred language is: <<If interpreter needed, which language>>		Insurance: <<Patient Demographics:Health Insurance>>	
Pension Card Number: <<Patient Demographics:Pension Number>>		Medicare Number: <<Patient Demographics:Medicare Number>>	

Would your patient prefer to use a private ED facility?:  <<Would patient prefer to use a private ED facility?>>	

Date patient consented to referral:  <<Miscellaneous:Date>>	
Consent to share informaton:  <<Consent to share information>>	
Patient consents to MBS bulk billing clinic if available: <<Consent to MBS bulk billing clinic>> 	

Clinical Information:		<<Patient Demographics:First Name>> <<Patient Demographics:Surname>> DOB:  <<Patient Demographics:DOB>>

Reason for patient referral: 
Suspected diagnosis:  <<Suspected diagnosis>>
<<Reason for Referral>>	

Inpatient consultant or registrar contacted about ED referral:  <<Consultant or registrar contacted about ED referral?>>
Consultant or registrar name:  <<Consultant or registrar name>>
Consultant or registrar advice:  <<Consultant or registrar advice>>
I have contacted the Barwon Health Duty Emergency Consultant on 4215 0136 to advise of this patient's arrival:  <<Barwon Health ED contacted on 4215 0136?>>	

Warnings: <<Clinical Details:Warnings>>
Allergies: <<Clinical Details:Allergies>> 
Social History: <<Clinical Details:Social History>> 
Smoking:  <<Clinical Details:Smoking>> 
If yes to smoking, has cessation program been discussed?:  <<if yes, has cessation program been discussed?>>
Alcohol history:  <<Clinical Details:Alcohol>>	
  
Current Medication:
<<Clinical Details:Medication List>>	

Past Medical History: 
<<Clinical Details:History List>>	

Progress Notes: 
<<Summary:Progress Notes (Selected)>>	

Investigation Results:
<<Summary:Investigation Results (Selected)>>	

Patient Name: <<Patient Demographics:Surname>>, <<Patient Demographics:First Name>>  DOB:  <<Patient Demographics:DOB>>

Barwon Health Emergency Department
Information for Patients

This information sheet is designed to explain what you can expect when you arrive at the Emergency Department at Barwon  Health. The thought of going to hospital may be worrying for you, so understanding what will happen when you arrive can help to reduce any anxiety you may feel.

Your doctor has decided it is necessary to refer you to the Emergency Department and this may be for a variety of reasons:
You may require further assessment that cannot be carried out at the doctor’s surgery.
You may need frequent monitoring that is best done in the Emergency Department.
Your doctor may want a second opinion from another doctor who specialises in emergency medicine.

What will happen when I arrive at the Emergency Department?
Everyone who presents at the Emergency Department must first be assessed by the Triage Nurse, who is highly trained in patient assessment. The nurse will ask you some questions, read the letter written by your doctor and briefly examine you. (Your doctor may have sent the letter via fax or given you a copy to hand over).  You will then be given a treatment category, which determines the urgency of your condition. Next, you must register with the administrative staff and then wait to be seen by a doctor. It is important during this time that you notify the Triage Nurse if your condition changes, or if you decide to leave. You must also check with the Triage Nurse before you eat or drink.

How long will I have to wait?
Patients are seen in the order of the urgency of their condition. Someone with a condition more urgent than yours will be seen by a doctor before you, even if you have been waiting much longer. Just because you have a letter from your doctor, or you arrive by ambulance does not mean you will be given priority.  
You can be confident that the Emergency Department staff are aware that you may be waiting. Every effort is made to ensure all patients are seen as promptly as possible. 

What are my responsibilities when I arrive?
Your doctor will either have given you a letter addressed to the Emergency Department or faxed it direct to the Emergency Department.  The letter outlines your current conditions, and lists your medications and past history. It is important that if you have the letter you give it to the Triage Nurse when you arrive. Ensure you have your Medicare cards, pension cards, health insurance details and any health care cards on hand, and you are able to provide the staff with the contact details for your next of kin. It is important that you follow any instructions given to you by the staff during your stay in the Emergency Department.    

Will I have to stay in hospital? 
Arriving at the Emergency Department does not mean you will definitely have to stay in hospital. If your condition improves, or your illness or injury can be treated within the Emergency Department, you may be advised that you can go straight home.
  
Who is responsible for my follow up care?
You may need to see your local doctor or return to the hospital for follow up care. 
If you go straight home from the Emergency Department, make sure you are given a letter to pass on to your local doctor so he/she knows what treatment or advice you received. It is also important that you know whether you need to make an appointment to see your local doctor, or have to return to the hospital. Ask the Emergency Department staff for advice if you are unsure about your follow up arrangements. 

The staff in the Emergency Department will be happy to answer any further questions you may have when you arrive. Detailed information pamphlets and privacy statements are available on request.