Regional referral forms

Publication name

Campus

Family Violence and Child Information Sharing Request Form

Campus: Wonthaggi Hospital, Phillip Island Community Hospital

pdf 33KB

Wonthaggi Hospital, Phillip Island Community Hospital

MR-280 Inpatient Services Referral Form

Campus: Wonthaggi Hospital, Phillip Island Community Hospital

pdf 261KB

Wonthaggi Hospital, Phillip Island Community Hospital

MR-302 Hospital in the Home - Medical and Iron Infusion Referral Form

Campus: Wonthaggi Hospital, Phillip Island Community Hospital

pdf 697KB

Wonthaggi Hospital, Phillip Island Community Hospital

MR-307 Self Referral Form

Campus: Wonthaggi Hospital, Phillip Island Community Hospital

pdf 715KB

Wonthaggi Hospital, Phillip Island Community Hospital

MR-309 Outpatient Specialist Clinic Referral Form

Campus: Wonthaggi Hospital, Phillip Island Community Hospital

pdf 156KB

Wonthaggi Hospital, Phillip Island Community Hospital

MR-310 Rapid Access Cardiology Referral Form

Campus: Wonthaggi Hospital, Phillip Island Community Hospital

pdf 735KB

Wonthaggi Hospital, Phillip Island Community Hospital

MR-313 Ambulatory Care Referral Form

Campus: Wonthaggi Hospital, Phillip Island Community Hospital

pdf 241KB

Wonthaggi Hospital, Phillip Island Community Hospital

MR-315 Counselling Referral Form

Campus: Wonthaggi Hospital, Phillip Island Community Hospital

pdf 165KB

Wonthaggi Hospital, Phillip Island Community Hospital

MR-316 Palliative Care Referral Triage and Transfer Form

Campus: Wonthaggi Hospital, Phillip Island Community Hospital

pdf 507KB

Wonthaggi Hospital, Phillip Island Community Hospital

Matching forms with services

Self-Referral Form
Cardiac Rehabilitation, Diabetes Education, Dietetics, Disability Planning, Lymphoedema Management, Occupational Therapy, Orthotist, Physiotherapy, Pulmonary Rehabilitation,
Social Support Groups, Social Work, Speech Pathology, Stomal Therapy, Stop Smoking Support

MR-310 Rapid Access Cardiology Referral
Cardiology

MR-313 Ambulatory Care Referral
Continence Service, District Nursing, Health Independence Programs - Hospital Admission Risk Program and Post Acute Care,Integrated Chronic Disease Management (ICDM)

MR-315 Counselling Referral Form
Counselling Services | General | Sexual Assault

Family Violence and Child Information Sharing Request Form
Family Counselling

MR-309 Outpatient Specialist Clinic Referral
Dermatology, Diabetes General Medicine, Gastroenterology, General Surgery, Geriatric Medicine, Gynaecology, Haematology, Infectious Diseases, Integrated Chronic Disease Management (ICDM),
Nephrology, Neurosurgery consultations only, Oncology, Orthopaedic Surgery, Radiation Oncology, Respiratory & Sleep

More information

Clinically recommended guidance for referrers is available through Gippsland Pathways.

Prior to referral, please check and ensure all referrals for Specialist Outpatient Clinics meet Statewide Referral Criteria and/or Minimum referral criteria, as well as local Bayside Health service eligibility.

All new referrals for Specialist Outpatient Clinics are processed by the Access Department.

The preferred method for external referrals to the Access Department is Fax: (03) 9102 5307.

Internal referrals from within BCH can be sent via email
Email: access@basscoasthealth.org.au
You can also contact our Access Team.
Phone: (03) 5671 3175

What happens next

Once we receive a referral we will review it to ensure:

We have all the information we need to progress
The referral meets the Minimum referral criteria, Statewide Referral Criteria (where applicable) as well as local service eligibility
Identify the best service/s to meet your patients needs and;
Assign a referral priority, urgent or routine

Please note, that the Department of Health states that we must not accept referrals that are incomplete or do not have the required information to assess.

Accepted referrals are triaged by our specialist doctors/nurses, as ‘urgent’ or ‘routine’.

High priority, ‘urgent’ access is assigned to patients that have a condition with potential to deteriorate quickly, with significant consequences for health and quality of life if not managed promptly.

For urgent referrals, we will contact the patient and aim to schedule an appointment within 30 days or at the earliest available time.

For routine referrals, we will notify you and the patient of a routine appointment date or the transfer onto a service waitlist and aim to schedule an initial appointment within 365 days.

Within 8 working days, we will send you written notification of the referral outcome, i.e. if the referral has been:

Accepted and an appointment has been scheduled
Accepted and the patient has been placed on a service waiting list
Not accepted and the reasons why