Chronic Disease Programs

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Emergency Referrals

Useful Management Information

This service is for patients who require complex diabetes care and would benefitfrom multidisciplinary team input.This service promotes self-management of conditions.

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 calendar days)	Intervention provided within 1-2 working days Symptomatic hyperglycemia: with blood glucose levels (BGLs) consistently >15mmol and /or blood ketones >1.0mmol Foot complications e.g. current ulcer, painful neuropathy with confirmed diabetes diagnosis QAS referrals where QAS deemed clients required transport to hospital, but client declined Intervention provided within 3-5 working days Following hospital presentation/admission relating to diabetes, e.g. DKA, severe hypoglycaemia, hyperglycemic state Recent or recurrent hypoglycaemia Hyperglycaemia BGLs consistently elevated >15mmol HbA1c>10% Commencing or changing insulin or other injectables QAS referrals where clients did not require transport to hospital but consented to referral Intervention provided within 6-14 working days Type 1 or Type 2 diabetes with one or more chronic conditions e.g. hypertension, CKD, dyslipidemia Comorbidity of anxiety, depression Polypharmacy Elderly, socially isolated, CALD HbA1c 8.1 - 10% Intervention provided within 15-28 working days Pre-diabetes/Impaired glucose tolerance Type 1 or type 2 diabetes for re-stabilisation / further education HbA1c <8%
Category 2 (appointment within 90 calendar days)	No category 2 criteria
Category 3 (appointment within 365 calendar days)	No category 3 criteria
If your patient does not meet the minimum referral criteria Assessment and management information may be found on a range of conditions at HealthPathways 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

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), 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

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

Type of diabetes and duration of disease
Weight, weight, BMI
Medical history
Presence of any complications e.g. CKD, retinopathy, gastroparesis, neuropathy
Foot complications (if applicable) e.g. current ulcer, painful neuropathy-refer to high risk foot criteria
Current Medication List
Allergies and adverse reaction

Pathology:

HbA1c & serial HbA1c (if available)
Fasting blood glucose or OGTT (if relevant)
Full lipid profile
Random urine albumin: creatinine ratio (ACR)
FBC
ELFTs

Additional Referral Information

Recent eye examination report (if applicable)
Social circumstances
Smoking status
Alcohol intake
Driving License status
Copy of GMP/TCA (if applicable)

Send Referrals To

Smart Referrals

Preferred Method
About Smart Referrals

Secure Web Transfer

Send to: Gold Coast Health Service District

Internal Referrals

Not Available

Fax

(07) 5687 4497

Post

Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215

Enquiries

1300 744 284

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

Dr Ben Chen

Facilities

Helensvale Community Health Centre

Robina Health Precinct

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

Chronic Disease Programs - Diabetes ManagmentAdult