Supporting Resources
2 Week Wait / Cancer
Brain CNS Cancer - Suspected - 2ww Referral
Updated March 2018
Breast Cancer - Suspected - 2ww Referral
Updated March 2018
Gynaecological Cancer - Suspected - 2ww Referral
Updated March 2018
Haematological Cancer - Suspected - 2ww Referral
Updated March 2018
Head & Neck Cancer - Suspected - 2ww Referral
Updated March 2018
Lower GI Cancer - Suspected - 2ww Referral
Updated October 2019
Lung Cancer - Suspected - 2ww Referral
Updated March 2018
Macmillan Next Steps
Updated June 2017
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Macmillan Next Steps- self referral
Updated June 2017
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Skin Cancer - Suspected - 2ww Referral
Updated March 2018
Soft Tissue Lump/Sarcoma - Suspected - 2ww Referral
New!   Updated last month
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Upper GI Cancer - Suspected - 2ww Referral
Updated March 2018
Urological Bladder and Renal Cancer - Suspected - 2ww Referral
Updated March 2018
Urological Penile Cancer - Suspected - 2ww Referral
Updated March 2018
Urological Prostate Cancer - Suspected - 2ww Referral
Updated March 2018
Urological Testicular Cancer - Suspected - 2ww Referral
Updated March 2018


Cardiovascular
Blood Pressure Monitor Referral Form
New!   Updated last month
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Cardiac Physiologist Ambulatory Monitoring Service
New!   Updated last month
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Cardiac Rehab Phase IV
Updated May 2018
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Cardiac Rehab Phase IV
Updated February 2016
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Cardiac Rehab Phase IV - Generic BACPR
New!   Updated last month
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Community Stroke Co-ordinator
Updated July 2019
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Direct Access 24 Hour ECG Monitoring - Holter Pilot Service - South Cotswolds Only
Updated August 2016
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Heart Failure Service - GP Referrals
New!   Updated last month
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Heart Failure Service - Inpatient
New!   Updated last month
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Rapid Access Chest Pain Clinic
New!   Updated January 2020
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Transient Ischaemic Attack (TIA)
New!   Updated January 2020


Care of the elderly
Better Balance Class Transfer Form for Physiotherapists
New!   Updated December 2019
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Better Balance Referral Form for GP's
New!   Updated December 2019
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Falls Assessment and Education Service (FAES)
New!   Updated January 2020
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Falls Assessment Clinic (FAC)
New!   Updated December 2019
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North Cotswold Frailty Service
Updated April 2019
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South Cotswolds Frailty Service
Updated June 2018
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Children & Young People
BCG Vaccination
Updated May 2016
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Children's & Young People's Physiotherapy Referral
New!   Updated last month
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Children's Weight Management Pilot - Forest of Dean and Gloucester City Only
New!   Updated January 2020
Gloucestershire Young Carers
Updated March 2019
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Occupational Therapy - Children and Young People (0-18 years)
New!   Updated last month
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Parenting Programme
Updated June 2019
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Safe Teenage Relationship Education & Empowerment Team Gloucestershire
Updated September 2019
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Safeguarding - Child Protection Conference Report
New!   Updated 3 days ago
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Safeguarding - Multi-Agency Service Request Form (MARF)
New!   Updated December 2019
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School Nurse Request Form
Updated October 2019
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Supporting Information from Education Setting (Neurobehavioural/Developmental Delay/LD)
Updated November 2019
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Dermatology
Botulinum Toxin for the Treatment of Hyperhidrosis - Prior Approval
Updated January 2017
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Dermatology - Lesion Referral Form - v2
Updated July 2018
Dermatology - Non Lesion Referral Form - v2
Updated July 2018
Dermatology Specials Ordering Form - GHNHSFT
Updated November 2018
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Skin and Subcutaneous Procedures and Treatments - Prior Approval
Updated January 2017
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Skin Cancer - Suspected 2ww Referral
Updated March 2018


Diagnostic Endoscopy
Lower GI - Colonoscopy & Sigmoidoscopy
Updated February 2018
Lower GI - Colonoscopy & Sigmoidoscopy
Updated February 2018
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Lower GI Endoscopy – Flexible Sigmoidoscopy
Updated August 2018
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Upper GI - Gastroscopy
Updated August 2018
Upper GI - Gastroscopy
Updated February 2018
Upper GI - Gastroscopy
Updated February 2018
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Diagnostic Imaging
CT/MRI - Direct Access
New!   Updated last month
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Dementia CT Scan Request Form
New!   Updated December 2019
Ultrasound (USS) - Direct Access
Updated December 2018
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Ultrasound / MRI / X-ray
Updated February 2018
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Disablement
Wheelchair Referrals for patients not known to Independent Living
Updated March 2019
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Ear, Nose & Throat
Community Microsuction
Updated July 2019
Hearing Aid - Direct Access 18 Week Pathway
Updated November 2009
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End of Life / Palliative Care
Community Specialist Palliative Care Nursing Service
New!   Updated 6 days ago
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Gloucestershire Coroner's Referral Form
New!   Updated December 2019
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Herefordshire Coroner's Referral Form
New!   Updated last month
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Palliative Care
Updated November 2019
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Endocrinology & Diabetes
Community Diabetes Service (CDS)
New!   Updated January 2020
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Community Diabetes Service (CDS) Education
New!   Updated last month
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NHS Diabetes Prevention Programme (NDPP)
Updated July 2019
Podiatry
New!   Updated last month
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Podiatry Urgent Diabetic Foot Clinic
Updated February 2018
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Specialist Diabetes Service
Updated April 2018
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Fertility & Pregnancy
Mummy & Me - Exercise Class (Stroud district only)
New!   Updated last month
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Pregnancy Advisory Service
Updated July 2019
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Gynaecology
Female Sterilisation - Prior approval
New!   Updated last month
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Hysteroscopy Service for Menstrual Disorders - Direct Access
Updated April 2017
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Lifestyle & Wellbeing
Art on Prescription Courses - SGS College
Updated April 2019
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Artlift (Arts on Prescription)
Updated July 2019
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Cheltenham Borough Homes Residents Support Service
Updated April 2016
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Community Wellbeing Service (Social Prescribing) - Cheltenham & Tewkesbury
Updated July 2019
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Community Wellbeing Service (Social Prescribing) - Cotswolds (South and North)
Updated July 2019
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Community Wellbeing Service (Social Prescribing) - Forest of Dean
Updated November 2019
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Community Wellbeing Service (Social Prescribing) - Gloucester
Updated July 2019
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Community Wellbeing Service (Social Prescribing) - Stroud & Berkeley Vale
Updated July 2019
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Complex Care at Home - Cheltenham and Gloucester
Updated May 2018
Complex Care at Home - Forest of Dean
Updated May 2019
Forwards Work Club
Updated February 2018
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GL Communities- Money Advice Service- Gloucester
Updated April 2017
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Gloucestershire Community Drug & Alcohol Recovery Service (Change Grow Live - CGL)
Updated December 2016
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Healthy Lifestyles Service
Updated October 2019
Live Better to Feel Better Gloucestershire Self Management Referral
Updated October 2018
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One Church Housing Programme
Updated April 2018
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Sleepstation
New!   Updated December 2019
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Youth Support Team
Updated August 2015
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Lymphoedema
Lymphoedema Service
New!   Updated January 2020
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Mental Health
Alexandra Wellbeing House
Updated October 2019
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Alzheimer's Society Referral
Updated June 2014
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Autism Spectrum Condition Service
New!   Updated January 2020
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Eating Disorders Service
New!   Updated January 2020
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Infant Mental Health Service
New!   Updated January 2020
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Memory Assessment Service (MAS)
New!   Updated 2 weeks ago
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Mental Health Intermediate Care Team (MHICT) - Incl Let's Talk - IAPT
New!   Updated last month
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Perinatal Mental Health Service
New!   Updated January 2020
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Nutrition & Dietetics
Essential Dietetic Information for Learning Disabilities
New!   Updated December 2019
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Nutrition and Dietetic Department
Updated December 2018
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Refractory IBS Service
Updated July 2018
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Slimming World Weight Management
Updated May 2017
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Specialist Weight Management Service (Tier 3)
Updated April 2017
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Ophthalmology
Blepharoplasty - Prior Approval
Updated January 2017
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Cataract Surgery
Updated February 2016
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Cataract Surgery
Updated April 2017
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Cataract Surgery
Updated October 2017
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Glaucoma
Updated April 2014
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Minor Eyelid Surgery - Prior Approval
Updated January 2017
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Wet AMD Rapid Access
Updated January 2013
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Oral & Maxillofacial Surgery
Dental
Updated February 2018
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Dento-Alveolar - Routine
Updated November 2018
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Oral Medicine & Intra-Oral Soft Tissue
Updated November 2018
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Temporo-Mandibular (TMJ)
Updated November 2018
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Third Molar Removal
Updated November 2018
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Orthopaedics / Musculoskeletal
Bone Health Service
Updated May 2019
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Chronic Pain MDT Team Referral
Updated July 2018
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Dupuytrens Surgery - Prior Approval
Updated January 2017
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Facet Joint Injections - Prior Approval
Updated December 2018
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Ganglia: Surgical Removal - Prior Approval
Updated January 2017
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Musculoskeletal (MSK) Referral Form
Updated November 2019
Physiotherapy Self-Referral
Updated April 2019
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Physiotherapy Self-Referral
Updated July 2018
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Podiatry
New!   Updated last month
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Surgical Foot Procedures - Prior Approval
Updated April 2018
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Trauma Referral Form
Updated November 2017
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Trigger Finger - Prior Approval
Updated January 2017
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Other
Advocacy Services (POhWER) Gloucestershire
Updated October 2019
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Botulinum Toxin for the Treatment of Chronic Anal Fissure - Prior Approval
Updated January 2017
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Cheltenham Locality - Request/Referral for Community Blood Test
Updated August 2019
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Cluster Multi-Disciplinary Team (MDT) Meetings
Updated June 2017
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Complex Leg Wound Service
New!   Updated last month
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Gloucestershire Leg Ulcer Service
Updated May 2019
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ICT Community Nursing
New!   Updated 4 weeks ago
ICT Community Therapy
New!   Updated January 2020
Longfield Hospice Day Services Referral
Updated August 2018
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Remote Monitoring (Telehealth)
Updated June 2018
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Tapentadol for the management of severe non-cancer pain in adults - Prior Approval
Updated July 2019
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Tissue Viability Service
New!   Updated last month
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Ventral Mesh Rectopexy and Stapled Transanal Rectal Resection (STaRR) - Prior Approval
Updated October 2018
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Pathology
Blood Transfusion Request
Updated August 2017
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Genetics Request Form
Updated June 2019
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Glucose Tolerance Test
Updated April 2017
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Physical Activity
Aqua Activity for Health - Stroud
New!   Updated December 2019
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Cancer Rehab Exercise Referral Form
Updated November 2019
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Exercise on Referral - Cotswolds
Updated February 2017
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Exercise on Referral - Cheltenham
Updated August 2019
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Exercise on Referral - Forest of Dean
Updated September 2016
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Exercise on Referral - Stroud
New!   Updated December 2019
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Rheumatology
Early Inflammatory Arthritis (EIA)
Updated November 2019


Social Care - Adults
Adult Social Care Helpdesk
New!   Updated last month
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Safeguarding Adults Referral Form
New!   Updated last month
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Speech & Language Therapy
Speech & Language Therapy - Adults
Updated August 2018
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Speech and Language Therapy - Children
Updated February 2019
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Urgent Care
Primary Care Transfer Form (NEWS)
Updated November 2017
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Urology
Community Urology Service
Updated September 2018
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Continence Service
Updated March 2019
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Hydroceles - Prior Approval
Updated January 2017
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Microwave or Laser Surgery for Benign Prostatic Hyperplasia - Prior Approval
Updated January 2017
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Urology One Stop
Updated February 2018