This is a dictation template to provide a reminder of the information required to complete the referral. The fields in red are mandatory and must be completed on the referral protocol.
Presenting Complaint
Main Presenting Complaint: [Beating the Blues Referral]
Has this been discussed with the patient:
- Yes
- No
If not discussed, please give explanation. (See Guidelines for contact details): [Text]
Date of Onset: [Date]
Priority: [Routine]
Is the patient currently taking anti-depressants:
- Yes
- No
Please indicate the persons education level:
- Primary
- Secondary
- Higher and/or University
- Other
Preferred method of communication:
- Phone or Text
- Letter
Please provide details if not complete:
Mobile phone number: [Text]
Email Address: [Text]