These forms should be used by GPs when making a referral via the Electronic Referral System.
ERS Referral Form - USC Urology (non-haematuria).docx
ERS Referral Form - Living with Diabetes Educational Service.doc
ERS Referral Form - Haematuria faster diagnostic pathway.docx
ERS Referral Form - FeNO and Spirometry CDC.docx
ERS Referral Form - Community Diagnostic Service - Phlebotomy Service
ERS Referral Form - Breast
ERS Referral Form - Children
ERS Referral Form - Combined Acute Community Trust Antibiotic Service
ERS Referral Form - Community Cardiology Tape / Echo
ERS Referral Form - Couples Subfertility Referral and Criteria
ERS Referral Form - CT Request Form
ERS Referral Form - CTS / Ulna Neuropathy
ERS Referral Form – eTIA
ERS Referral Form – Humber Neurology Service Guidance
ERS Referral Form – Humber Post COVID-19 Long Syndrome referral with MDT outcome
ERS Referral Form – Humber Post COVID-19 Long Syndrome referral without MDT outcome
ERS Referral Form – Malignancy of Unknown Origin (MUO)
ERS Referral Form - Routine Skin
ERS Referral Form - Orthotics
ERS Referral Form – Patient Urgent Suspected information leaflet
ERS Referral Form - PMB Ultrasound Request
ERS Referral Form – RACPC (Rapid Access Chest Pain)
ERS Referral Form – Radiology Plain Film Fluoroscopy Request
ERS Referral Form – Radiology MRI Request
ERS Referral Form - Radiology Rapid Diagnostic Service
ERS Referral Form - Radiology Rapid Diagnostic Service - History Questions
ERS Referral Form – Radiology Spinal MRI Request
ERS Referral Form - Radiology Walk in Chest Xray
ERS Referral Form - T4 Bariatric Surgery
ERS Referral Form - Transient Ischemic Attack (TIA)
ERS Referral Form - Ultrasound Request Form
ERS referral Form – USC Brain
ERS referral Form – USC Colorectal
ERS Referral Form – USC Gynaecology
ERS Referral Form – USC Head and Neck
ERS Referral Form – USC Hepatobiliary
ERS Referral Form – USC Lung
ERS Referral Form – USC Skin Cancer
ERS Referral Form – USC Upper GI
Page Created: 5th January 2018
Last Updated: 15th October 2025
Last Updated: 15th October 2025