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Refer your patient
Biopsy proven new diagnosis of lymphoma
Useful management information
- If the referring clinician organises a biopsy – please ensure a core or excisional biopsy (not a FNA) is performed along with flow cytometry
- Optimal cancer care pathway for people with Hodgkin and diffuse B-cell lymphomas
- Quick reference guide
Minimum referral criteria (Does your patient meet the minimum criteria?)
Does your patient meet the minimum referral criteria?
Category 1 If you feel your patient meets Category 1 criteria, please mark "urgent" on your referral |
# If any life threatening symptoms present (new hypercalcaemia) or severe or life threatening symptoms present (e.g. spinal cord compression, SVC compression, ureteric compression, airway compromise etc.) – then call the haematologist on call, or send direct to emergency. *Some CLL behaves very indolently and an appointment time within 90 days may be acceptable – this decision will be made by the triaging clinician. |
| Category 2 (appointment within 90 calendar days) |
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| Category 3 (appointment within 365 calendar days) |
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If your patient does not meet the minimum referral criteria
- Consider other treatment pathways or an alternative diagnosis
- If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested:
- Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
- Please note that your referral may not be accepted or may be redirected to another service
Standard referral information (To be included in all referrals)
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
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
- A comprehensive capture of information in relation to MSH Referral Criteria
Clinical modifiers
- The presence of clinical modifiers may impact the categorisation of the patient.
- Impact on employment
- Impact on education
- Impact on home
- Impact on activities of daily living functioning – low/medium/high
- Impact on ability to care for others
- Impact on personal frailty or safety
- Identifies as Aboriginal and/or Torres Strait Islander
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)
- Name of the parent or caregiver (if appropriate)
- Name of delegate and contact details (Department of Corrective Services)
- 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
Other relevant information
- Willingness to have surgery (where surgery is a likely intervention)
- Choice to be treated as a public or private patient
- Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
Essential referral information for Biopsy proven new diagnosis of lymphoma referrals (Referral will be returned without this)
- Detailed history of present signs and symptoms
- Past medical history/pertinent social history
- Current medications and allergies
- Histology report
- FBC, U&E, LDH results
If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons a Clinical Override may be requested. This reason must be clearly articulated in the body of the referral.
Additional referral information for Biopsy proven new diagnosis of lymphoma referrals
Histological diagnosis does not necessarily predict clinical behaviour and as such, some low grade lymphomas may be treated as Cat 1 urgent and some aggressive lymphomas may be treated as Cat 2. This decision should always be made on clinical assessment
Out of catchment
Metro South Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro South Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.
Last updated 1 November 2018