Pulmonary Rehabilitation

Pulmonary Rehab from GPs, Acute Trusts and patients

Please note: this form is for patients registered with Greater Huddersfield CCG only

GP Practices in Greater Huddersfield Pulmonary Rehabilitation Service

Referral criteria

• respiratory disease
• independently mobile and no transport required
• must be able to commit to attending Pulmonary Rehabilitation for 16 sessions over 8 weeks
• must be motivated to attend and make changes to their lifestyle
• are happy in a group environment and will actively participate in the programme
• have a MRC score of 3 or greater

Exclusion criteria. Please contact to discuss if required.

Acute Left Ventricular Failure (LVF)
Uncontrolled cardiac arrhythmia
Uncontrolled angina
Cerebral Vascular Accident/neurological incident within last 3 months
Pulmonary embolus/Deep Vein Thrombosis within last 3 months not receiving treatment
Abdominal Aortic Aneurysm (AAA) > 5.5cm or any AAA with uncontrolled BP
Aortic stenosis
Surgery within 6 weeks
Acute/current psychotic episode
Alcoholism affecting life
Any medical problems preventing exercise or compliance with programme
Attending other rehab programme

Referrer Details
If contact details are incorrectly input where mandatory the referral cannot be processed

Patient Details
If contact details are incorrectly input where mandatory the referral cannot be processed

Overseas visitor?

Patient Condition Information
All questions marked with a * should be answered

If not recently recorded in the patient's record, what is the current Medical Research Council Dyspnoea Score Chart (MRC)?

Is the patient receiving long term oxygen or ambulatory therapy?*

What You Need To Do Next
Supporting documents required with this referral

For any issues with this referrla form please contact Locala Single Point of Contact – 0300 304 5555

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