Referral Forms for WCH Outpatient Clinics
The WCHN recommends that referring clinicians use the supplied referral templates and forms to assist with appropriate and timely triage of patient’s referrals.
All referral forms are available in Microsoft Word or PDF document format.
Some referral templates have been adapted for clinical software systems and can be downloaded into clinical software. This will save time for referring clinicians.
WCH Referral Forms
WCH Clinic-specific Forms
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Child Development Unit (CDU) Referral Form
(63KB DOCX)
-
COVIDKids Referral Form
(453KB RTF)
Updated: Sep 2022
-
Burns Service Referral Form
(42KB DOC)
-
Burns Assessment (Paediatric) Form
(245KB PDF)
-
Neurology Electrophysiology/EEG Request Form
(284KB PDF)
-
Specialist Immunisation Service / Medically-at-Risk Immunisation Referral Form
(219KB PDF)
-
Gender Diversity Clinic Referral Form
(699KB PDF)
Templates for GP/Referring Clinician Software
These referral templates are designed to be downloaded into Best Practice medical software systems. If you do not have Best Practice, use the Word document version above.
These referral templates are designed to be downloaded into Medical Director medical software systems. If you do not have Medical Director, use the Word document version above.
These referral templates are designed to be downloaded into Zedmed medical software systems. If you do not have Zedmed, use the Word document version above.
Web-based Referral Form
Please note:
- The web-based form has been decommissioned – it will be replaced by a new e-Referral system in the coming months. In the meantime, please use the Word version of the paediatric outpatient referral form:
Further Information
All versions of the referral form should be signed by the referring medical practitioner prior to faxing it to the WCH Administration Hub at 08 8161 6246. If you are sending electronically, add an electronic GP signature to your template.
Referrals will only be accepted on one of the official forms, as outlined above. We cannot accept referral forms that are incomplete or that have not been signed by the referring medical practitioner.
Best Practice Instructions
- Download the template from the link and click “Save As”.
- Save the template where it may be easily accessed for import to Best Practice.
- Import into Best Practice.
Medical Director Instructions
- Download the template from the link and click “Save As”.
- Save the template where it may be easily accessed for import to Medical Director.
- Import into Medical Director.