Sample resource / For veterinary teams
Referral information outline
A sample professional checklist for organising the context of a rehabilitation referral.
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Dog’s name:
Your name / date:
The referral question
Reason for referral and the clinical questions to address:
Space for handwritten notes
Relevant veterinary findings, diagnoses and investigations:
Space for handwritten notes
Current clinical context
Current treatment and instructions:
Space for handwritten notes
Restrictions, precautions and information affecting assessment:
Space for handwritten notes
The dog and owner
Relevant everyday function, owner priorities and practical circumstances:
Space for handwritten notes
Handling, behaviour, communication or access considerations:
Space for handwritten notes
Records and permissions
Which clinical records accompany the referral?
Space for handwritten notes
Which referral or sharing authorisation needs to be confirmed?
Space for handwritten notes
Communication arrangements
Referring practitioner and verified practice contact route:
Space for handwritten notes
What update is requested, for what purpose and by which agreed route?
Space for handwritten notes