Referral Forms and Guidance
The electronic Specialist Palliative Care referrals forms below have been produced by South Birmingham PCT as part of a joint project between the PCT and Birmingham St Mary's Hospice, with funding from West Midlands Workforce Deanery .
The "electronic End of Life Pathway Project" has helped the Birmingham St Marys Hospice team to connect to the NHS network, to implement SystmONE as the hospice clinical IT solution and to develop a shared record with Sandwell Palliative Care Teams and Lordswood Health Centre.
It is hoped that the forms below will help GPs across Birmingham, Sandwell and Solihull to refer patients to their local hospice more easily.
The time saved by automatic merging of patient demographic details from GP systems, can then be used to provide more detailed information in the clinical sections of the form.
EMIS LV
Adult_Specialist_Palliative_Care_Referral_Form_EMIS_LV
Adult_Specialist Palliative Care_referral_guidance_for_EMIS_LV
EMIS PCS
Specialist_Palliative_Care_referral_form_EMIS_PCS
Adult_SPC_referral_guidance_EMIS_PCS
Synergy
Adult_Specialist_Palliative_Care_Referral_Form_Synergy
Vision
Referral_to_specialist_palliative_care_Vision
Adult_SPC_referral_guidance_Vision
SPC Referral Form - Protected Word Form
The following form can be completed electronically but should be faxed to 0121 472 4159, or posted to BSMH. We are currently unable to accept referrals via NHSmail, however, we will update this page when the facility becomes available.
Adult_SPC_Referral_Form_2010_Protected
Further information
Should you have difficulty with any of the templates or instructions above then please contact Laura McElroy at South Birmingham PCT. laura.mcelroy@nhs.net
If you would like further information about the "electronic End of Life Pathway (eEoLP)" or the proposed "End of Life Template - Enhanced Summary Care Record" Projects then please contact Dr Steve Plenderleith, Medical Director, Birmingham St Mary's Hospice. steve.plenderleith@bsmh.org.uk
Patient Information
You can download our patient information book by right clicking and selecting 'Save As'
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