Forms

Electronic versions of forms in use in Birmingham

Here you will find downloadable forms regularly used in Birmingham.

You may download them onto your own computer and personalise a copy for each member of the professional staff, save on the practice system desk top then complete as and when you have a patient that needs to be referred.

 

The GOS18 is the new version published towards the end of 2014 and should be used for all referrals to the HES or to a GP.  Unfortunately any tick boxes will have to be done by hand once the completed form is printed off

 

The Direct Cataract Referral form is in two parts, C1 and C2.  The C1 is faxed to the provider and copied to the GP whilst the C2 should be signed by the patient and kept in the practice for audit purposes.  Again tick boxes have to be completed by hand after printing

 

Each area has a slightly different Wet AMD Rapid Access Referral form so there is one each for Heart of England Foundation Trust, Sandwell and West Birmingham Hospitals Foundation Trust and University Hospitals Birmingham Foundation Trust.  Please ensure that you use the correct form for the hospital to which you are referring.

 

Please click on the form that you need opposite and then click the link below.