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ERS Referral Forms

Communications Team5th January 2018

These forms should be used by GPs when making a referral via the Electronic Referral System.

ERS Referral Form - USC Urology (non-haematuria).docx

429.32 KB

ERS Referral Form - Living with Diabetes Educational Service.doc

563 KB

ERS Referral Form - Haematuria faster diagnostic pathway.docx

56.84 KB

ERS Referral Form - FeNO and Spirometry CDC.docx

194.84 KB

ERS Referral Form - Community Diagnostic Service - Phlebotomy Service

45.18 KB

ERS Referral Form - Breast

238 KB

ERS Referral Form - Children

174 KB

ERS Referral Form - Combined Acute Community Trust Antibiotic Service

14.56 KB

ERS Referral Form - Community Cardiology Tape / Echo

503 KB

ERS Referral Form - Couples Subfertility Referral and Criteria

91.5 KB

ERS Referral Form - CT Request Form

193.81 KB

ERS Referral Form - CTS / Ulna Neuropathy

101 KB

ERS Referral Form – eTIA

83.1 KB

ERS Referral Form – Humber Neurology Service Guidance

74 KB

ERS Referral Form – Humber Post COVID-19 Long Syndrome referral with MDT outcome

31.22 KB

ERS Referral Form – Humber Post COVID-19 Long Syndrome referral without MDT outcome

29.41 KB

ERS Referral Form – Malignancy of Unknown Origin (MUO)

200.5 KB

ERS Referral Form - Routine Skin

99.5 KB

ERS Referral Form - Orthotics

167.54 KB

ERS Referral Form – Patient Urgent Suspected information leaflet

726 KB

ERS Referral Form - PMB Ultrasound Request

205 KB

ERS Referral Form – RACPC (Rapid Access Chest Pain)

68 KB

ERS Referral Form – Radiology Plain Film Fluoroscopy Request

193.83 KB

ERS Referral Form – Radiology MRI Request

194.59 KB

ERS Referral Form - Radiology Rapid Diagnostic Service

194.85 KB

ERS Referral Form - Radiology Rapid Diagnostic Service - History Questions

918.5 KB

ERS Referral Form – Radiology Spinal MRI Request

200.11 KB

ERS Referral Form - Radiology Walk in Chest Xray

191.32 KB

ERS Referral Form - T4 Bariatric Surgery

32.89 KB

ERS Referral Form - Transient Ischemic Attack (TIA)

56.2 KB

ERS Referral Form - Ultrasound Request Form

208 KB

ERS referral Form – USC Brain

146.07 KB

ERS referral Form – USC Colorectal

235 KB

ERS Referral Form – USC Gynaecology

125 KB

ERS Referral Form – USC Head and Neck

148.5 KB

ERS Referral Form – USC Hepatobiliary

88.5 KB

ERS Referral Form – USC Lung

135.5 KB

ERS Referral Form – USC Skin Cancer

105 KB

ERS Referral Form – USC Upper GI

62.23 KB

Page Created: 5th January 2018
Last Updated: 15th October 2025