Heart Failure

Heart Failure eReferral

Criteria
A confirmed diagnosis of any of the following:*
Plus 1 or more of the following: (Tick as appropriate)*
Patient Details
If contact details are incorrectly input where mandatory the referral cannot be processed
Patient has consented to information sharing?*
Overseas visitor?
Is the patient's main language English?
If no, what is the patient's main spoken language?
Does the patient require an interpreter?
Can the patient communicate easily?
Optional Attachment
GP Details
Referral
Where is the patient on referral?*
Can the patient open their door?
Referrer Details
If contact details are incorrectly input where mandatory the referral cannot be processed
If you do not receive an email acknowledgement your referral has not been submitted. Please check that all details are correct, mandatory fields completed and re-submit.