How to refer
Clinicians may refer using the form below or by phoning 020 8768 4582 (9am to 5pm Monday to Friday) or 020 8768 4500 (24 hours). Please telephone for all emergency referrals.
Once completed please email to firstname.lastname@example.org.
Please make sure that you send this form using a secure email account such as NHS email.
From Monday 8 November all referrals to St Christopher’s will require the following information to be completed;
- Demographics of the patient you are referring including their NHS number
- Does the person have a package of care? If yes, the source of funding and agency involved
- Consent from the patient that they understand that they are being referred to St Christopher’s Hospice
- Primary diagnosis
- Clarity about whether it is an admission to the Inpatient Unit or to our community services you are requesting
- Infection status of the patient
- Referrers name and contact details
- Brief history and key treatments
- Brief summary of current palliative care needs and what is expected to be achieved from the referral
- Past medical / psychiatric history
- If any of the boxes on the form are left blank or state “see attached” our admin team will return this and request that the form be completed to our minimum requirements
- The form WILL NOT be reviewed by a clinical member of the team before it is returned
- Please do not cut and paste from hospital records and please summarise on the referral form any attached information
If you would like to integrate our referral form into your electronic patient record system, please email email@example.com
We welcome discussion with community or hospital colleagues about cases where they need urgent advice, are uncertain whether to refer or need help signposting to other services. Advice for professionals from senior medical and nursing staff is available 24 hours a day (020 8768 4500). Anticipatory prescribing for end of life guidance can be found here.