Referral forms

Chris O’Brien Lifehouse physicians are experts in the fields of cancer diagnosis, research and treatment. If you are a medical practitioner wanting to refer a patient, please browse our list of oncologists, specialists and surgeons by speciality and then fill in the relevant referral form below.

Instructions

The templates provided by us are for your personal use only and must not be redistributed without permission. They have been tested with the versions of Best Practice (1.8.4.642) and Medical Director (MD3.16).

How to import templates

These templates have been specifically made to be imported to your software or for use by printing out and handwriting in the form itself. The following documents can be downloaded to provide instructions on how to import these templates to your program of choice.

document-pdf-text Importing Templates into Best Practice from our Website

document-pdf-text Importing Templates into Medical Director from our Website

What is an Open template?

BP or MD templates should not be opened and viewed before downloading them into your practice software. An OPEN template, which is the PDF version of a template, allows you to open and view the template before downloading it into your practice software. You can also use the Open version to complete assessments without going through the practice software.

What if I do not use Best Practice or Medical Director?

Click on the PDF link below , which will let you open the smart PDF document/form to fill out. You can then print or email the filled out form to us at Clinics@lh.org.au.

Clinic PDF Best Practice Medical Director
Chris O’Brien Lifehouse – GP Referral
Medical Imaging Request
Head & Neck
Priority Access – Prostate
Rapid Access Endoscopy
Gynaecological
Gastro & uro-oncology Group

Specific clinic referrals

Breast

This is a public clinic that runs Tuesdays, Wednesdays and Thursdays in the afternoons. Your patient will be assigned a Lifehouse doctor and will be allocated an appointment based on clinical priority. Breast surgeons see new patients on all three days while breast physicians see new patients on Tuesday afternoons. As part of the triage process we will determine whether your patient needs a consultation with a breast surgeon or physician.

To refer a patient you need to send us a referral letter along with the patient’s relevant medical imaging.

  1. Address your referral to:
    Breast Clinic
    Chris O’Brien Lifehouse
    119-143 Missenden Road,
    Camperdown NSW 2050
  2. Fax the form and test results
    Send the completed referral letter by fax to (02) 9519 9214 or email BreastClinic@lh.org.au and include all recent breast imaging (mammogram and/or ultrasound) and, if applicable, biopsy results.

Please note that all new Breast Clinic patients must have their imaging completed externally before attending the clinic and those reports must be faxed with the referral.

Once this is received, the referral will be triaged and our Breast Patient Navigator will contact the patient to arrange an appointment. If you or your patient have any questions about the referral process or the clinic you can contact our Breast Patient Navigator on (02) 8514 0255.

Clinical Trials

If you would like to refer a patient to a Lifehouse clinical trial you need to complete a referral form or draft a referral letter and send it through to the attention of the trial’s Lead Investigator. The Lead Investigator will then be in touch with the patient directly to assess their eligibility.

A list of trials open for recruitment can be found here.

Once you’ve identified the right contact from the above list, simply call our switchboard on 1300 852 500 and ask to be put through to them to get the appropriate contact details.

Complementary Therapies and Supportive Care Services

If you wish to refer a patient to a Supportive Care Service Provider or Complementary Therapy service, please contact the LivingRoom (supportive care and complementary therapies provider) to organise an appointment.

Call us on (02) 8514 0038 or email us at livingroom@lh.org.au. Completed referrals can be faxed to the LivingRoom on (02) 9383 1038 or the patient can bring the form along to their first consultation.

Medicare rebates are available for exercise physiology and dietitian appointments following GP completion of a chronic disease management plan.

Most of the LivingRoom services are eligible for private health fund rebates.

Gynaecological Oncology

The gynaecological oncology clinics run every day. Patients are seen for colposcopy or for suspected/confirmed gynaecological cancer. Referrals are made using the Lifehouse referral form (see below) and can be on a private, general or public basis.

Private clinics – patients require a referral to a specific clinician. Billing occurs at the time of consultation and Medicare rebates can be claimed on site.

General clinic – patients require a referral to a specific clinician or to the next available clinician. Because this is usually a teaching clinic the patient may see a fellow or registrar prior to the consultant. Patients are billed the scheduled MBS fee and can claim the Medicare rebate following the consultation. Patients who have a Centrelink Health Care Card or Pension Card will be bulk billed. For urgent cases or to ensure your patient sees the first available specialist, please tick the default option on the referral form which specifies any of our clinicians.

Public clinic – We run weekly public clinic. Availability in the public clinic is very limited, your patient will be seen by an assigned Lifehouse specialist.

Your patient will be allocated an appointment based on clinical priority and availability.

  1. Fill out the Gynaecological Oncology referral form
    Right click on the .pdf link from the list above and download it to your computer. Use Acrobat Reader to to fill the form in and email it using the button on the bottom of the form. You can type the details in your browser and then email or print the form.
  2. Indicate the name of a Lifehouse clinician
    Select the desired specialist or, to see the first available specialist choose the default option which specifies any of our clinicians:
    Professor Jonathan Carter (Head of Dept)
    Clin A/Professor Selvan Pather
    Clin A/Professor Sam Saidi
    Clin A/Professor Trevor Tejada-Berges
  3. Fax the form and test results
    Send the completed form by fax to (02) 9383 1031 or email Gynae.Oncology@lh.org.au and include any relevant test results (e.g. pap smear, ultrasound or scan)

Once this is received, the referral will be triaged and our Gynaecological Oncology Patient Navigator, Christine Young, will contact the patient to arrange an appointment.

If you or your patient have any questions about the referral process or the clinic you can contact Christine (02) 8514 0262.

Head and Neck
SPECIFIC REFERRAL FORMS

To refer a patient you need to send us a referral letter along with the patient’s relevant medical imaging and/or test results.

  1. Address your referral to:
    Head and Neck Clinic
    Chris O’Brien Lifehouse
    119-143 Missenden Road,
    Camperdown NSW 2050
  2. Fax the form and test results
    Send the completed form or referral letter by fax to (02) 9383 1033 or email to headandneck@lh.org.au and include any relevant test results showing anomalies.

Once this is received, the referral will be triaged and our Head and Neck Patient Navigator will contact the patient to arrange an appointment. If you or your patient have any questions about the referral process or the clinic you can contact us on (02) 8514 0683.

Medical Oncologist

To refer a patient to a medical oncologist:

  1. Complete a referral form
    You can download a general Lifehouse referral form from the top of this page. Alternatively you can draft a referral letter including the reason for the referral and the relevant medical history.
  2. Indicate the name of the appropriate oncologist
    All referrals must indicate a specific clinician. A list of our oncologists is available here.
  3. Fax the completed referral form/letter
    Send the completed form by fax to (02) 9383 1014 and include any relevant test results showing anomalies.Once this is received, the referral will be triaged by our patient navigation team, and the appropriate patient navigator or VMO will contact the patient to arrange an appointment.Your patient will see the doctor you’ve indicated on the referral form/letter.
Priority Access Prostate Cancer Assessment Service

Aim of Referral

  • From GP to priority access prostate cancer screening service within two weeks

Referral Criteria

  • Patients with family history of prostate cancer
  • Abnormal DRE regardless of PSA
  • Elevated PSA
  • Abnormal PSA levels
  • Abnormal changes in PSA over time
  • Patients over 50 years of age

How to refer – use one of the following options

  • GP to complete online referral form
  • Referral can be to the next available Priority Access Prostate Cancer Assessment Service doctor or to a specific doctor. Either selection must be indicated on referral
  • The completed referral should be faxed (02 9383 1000) or emailed (prostateclinic@lh.org.au) to Lifehouse Priority Access Prostate Cancer Assessment Service
  • Referral forms can be download loaded using Best Practice or Medical Director software or in PDF version

If you need help

  • Please call the Urology Department on 02 8514 0432 for any questions or to clarify a process
Radiation Oncologist

To refer a patient to a Radiation Oncologist:

  1. Complete a referral form
    You can download a general Lifehouse referral form from the top of this page. Alternatively you can draft a referral letter including the reason for the referral and the relevant medical history.
  2. Indicate the name of the appropriate oncologist
    All referrals must indicate a specific clinician. A list of our radiation oncologists is available here.
  3. Fax the completed referral form/letter
    Send the completed form by fax to (02) 9383 1071 and include any relevant test results and imaging reports, as well as the patient’s contact information. Once this is received, the referral will be triaged by our patient navigation team, and the appropriate patient navigator will contact the patient to arrange an appointment. Your patient will see the doctor you have indicated on the referral form/letter.
Rapid Access Endoscopy Service

To refer a patient to the Rapid Access Endoscopy Service, GPs should complete the specific referral form above.

Aim of Referral

  • From GP to endoscopy within two weeks
  • Fit and well patients will have endoscopy without a consultation prior
  • Patients with a remarkable medical history may require a consultation first

At time of referral

  • GP to complete as many details on the referral form as possible, in particular a contact number for the patient
  • Referral can be to the Rapid Access Endoscopy Medical team or a specific doctor but either selection must be indicated on referral
  • The completed referral should be faxed (02 9383 1090) or emailed (endorapidaccess@lh.org.au) to Lifehouse
  • The patient will then be booked on the theatre list and sent a Lifehouse welcome pack
  • Any missing information will be followed up by the Lifehouse Surgical Admissions reception staff

If you need help

Please call the Surgical Admissions team on 02 8514 1000 for any questions or to clarify a process

Start typing and press Enter to search