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Does your patient meet the minimum referral criteria?
(appointment within 90 calendar days)
(appointment within 365 calendar days)
NB: asymptomatic epiretinal membranes with good BCVA should not be referred
If your patient does not meet the minimum referral criteria
Reason for request
Relevant clinical information about the condition
Patient's Demographic Details
Referring Practitioner Details
Other relevant information
NB: Patients are expected to be able to sit in an examination chair for Slit Lamp inspection of their eyes. It will be assumed that this is possible unless clearly stated on the referral. While all other options will be considered, it should be noted that in some cases it is not always possible.
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.
If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
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.