Asthma

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Useful Management Information

No day or night symptoms
Minimal or no need for beta agonist treatment (less than 2 times per week)
No exacerbations
No limitations on physical activity
Minimal side effects of treatment

Clinician resources

Patient resources

Minimum Referral Criteria

Category 1	History of life-threatening asthma in the past 12 months requiring ventilation or ICU admission Unstable asthma with consistent FEV1 < 60% predicted Asthma caused or exacerbated by workplace exposure where patient is unable to work as a result
Category 2	Inadequate asthma control as defined in Other useful information despite optimal treatment Asthma related hospital admission/s in the last 3 months Need for oral corticosteroids on more than 1 occasion in the last year Asthma with frequent after-hours attendance (ED or after-hours GP) despite optimal treatment Asthma caused or exacerbated by workplace exposure where patient is still able to work as a result
Category 3	Uncertainty about diagnosis Asthma education where this cannot be provided in the community
If your patient doesn't meet the minimum referral criteria If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.) Please note that your referral may not be accepted or may be redirected to another service.

Standard Referral Information

Reason for request

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can't order, or the patient can't afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
All conservative options that have been pursued unsuccessfully prior to referral
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

Willingness to have surgery (where surgery is a likely intervention)
Choice to be treated as a public or private patient
Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

Essential Referral Information

Approximate age at diagnosis
Duration and severity of symptoms (breathlessness, chest tightness, wheezing and cough)
Frequency of exacerbations
Management including:
- current medications (including complete list of all patient’s medications)
- previously tried respiratory medications
Oral prednisolone use
Previous hospitalisations for asthma
Allergies
Spirometry (if available)

If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons a Clinical Override may be requested. This reason must be clearly articulated in the body of the referral.

Additional Referral Information

Allergy testing results
Triggers
Assessment of adherence to treatment
Smoking status
Family history of asthma
FBC
Chest X-Ray
Comorbid conditions

Send Referrals To

Smart Referrals

Not available

Internal Referrals

Not available

Fax

Not available

Post

Not Available

Enquiries

Not available

Service Availability

Facilities

Gold Coast University Hospital

Robina Hospital

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

Asthma

Useful Management Information

Minimum Referral Criteria

If your patient doesn't meet the minimum referral criteria

Essential Referral Information

Additional Referral Information

Send Referrals To

Smart Referrals

Internal Referrals

Fax

Post

Enquiries

Service Availability

Facilities