NSW Pain Clinic Referral Form and Process
To provide a consistent method when making a referral from primary care to a tertiary pain service, irrespective of where the service is located.
All services will have the same triage criteria and process for accepting patients from primary care.
To standardise agreements and processes when referring patients to a NSW statewide pain-management service.
A statewide referral form was developed through a process of consensus and working-group activity, and this form has been adopted statewide.
- Clinical Excellence Commission (CEC)
- Local Health Districts
- NSW Therapeutic Advisory Group (NSW TAG)
|Central Coast Local Health District||Central Coast Local Health District|
|Far West Local Health District||Far West Local Health District|
|Hunter New England Local Health District||Hunter New England Local Health District|
|Illawarra Shoalhaven Local Health District||Illawarra Shoalhaven Local Health District|
|Mid North Coast Local Health District||Mid North Coast Local Health District|
|Murrumbidgee Local Health District||Murrumbidgee Local Health District|
|Nepean Blue Mountains Local Health District||Nepean Blue Mountains Local Health District|
|Northern NSW Local Health District||Northern NSW Local Health District|
|Northern Sydney Local Health District||Northern Sydney Local Health District|
|South Eastern Sydney Local Health District||South Eastern Sydney Local Health District|
|South Western Sydney Local Health District||South Western Sydney Local Health District|
|Southern NSW Local Health District||Southern NSW Local Health District|
|St Vincent's Health Network||St Vincent's Health Network|
|Sydney Children's Hospital Network||Sydney Children's Hospitals Specialty Network|
|Sydney Local Health District||Sydney Local Health District|
|Western NSW Local Health District||Western NSW Local Health District|
|Western Sydney Local Health District||Western Sydney Local Health District|
Key Date (location) Pilot Site Implementation Site
The form has been evaluated by sites participating in the pilot, but it will be modified upon receipt of feedback as appropriate.
For more information go to the WentWest Information Management/Information Technology (IM/IT) webpage and see Westmead Chronic Pain Service Referral - Westmead Hospital.
Manager, Pain Management Network
02 9464 4636
Director, Primary Care and Chronic Services
02 9464 4603
Page Top | Added: 7 November 2013 | Last modified: 17 November 2014