Tag: acne

Acne Referral Template

Scott McLaughlin

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: [Text – 98 character maximum]

Reason for Referral: [Text]

Date of Onset: [Date]

Priority:

  • Routine
  • Urgent

Priority Reason: [Text – 98 character maximum]

Acne Severity:

  • Mild
  • Moderate
  • Severe nudulocystic

Acne referral guidelines

Acne

Scott McLaughlin

Before referring a patient for acne, they must have met the following criteria:

  • The patient has been treated with 2 courses of oral antibiotics for at least 3 months
  • The patient has essentially normal U and E’s, LFT’s, lipids and plasma glucose. (Please append results if possible)
  • Female patients referred for consideration of Roaccutane therapy should be established on contraception PRIOR to referral. (eg Dianette)

Please ensure that all antibiotics prescribed for acne are listed in the medication page of the referral protocol.

Acne Referral Template