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)

Key Dates

Pilot Sites

Implementation Sites

Central Coast Local Health DistrictCentral Coast Local Health District
Far West Local Health DistrictFar West Local Health District
Hunter New England Local Health DistrictHunter New England Local Health District
Illawarra Shoalhaven Local Health DistrictIllawarra Shoalhaven Local Health District
Mid North Coast Local Health DistrictMid North Coast Local Health District
Murrumbidgee Local Health DistrictMurrumbidgee Local Health District
Nepean Blue Mountains Local Health DistrictNepean Blue Mountains Local Health District
Northern NSW Local Health DistrictNorthern NSW Local Health District
Northern Sydney Local Health DistrictNorthern Sydney Local Health District
South Eastern Sydney Local Health DistrictSouth Eastern Sydney Local Health District
South Western Sydney Local Health DistrictSouth Western Sydney Local Health District
Southern NSW Local Health DistrictSouthern NSW Local Health District
St Vincent's Health NetworkSt Vincent's Health Network
Sydney Children's Hospital NetworkSydney Children's Hospitals Specialty Network
Sydney Local Health DistrictSydney Local Health District
Western NSW Local Health DistrictWestern NSW Local Health District
Western Sydney Local Health DistrictWestern Sydney Local Health District


The form has been evaluated by sites participating in the pilot, but it will be modified upon receipt of feedback as appropriate.

Related Initiatives

Further Details

For more information go to the WentWest Information Management/Information Technology (IM/IT) webpage and see Westmead Chronic Pain Service Referral - Westmead Hospital.


Jenni Johnson
Manager, Pain Management Network
02 9464 4636

Chris Shipway
Director, Primary Care and Chronic Services
02 9464 4603

Page Top | Added: 7 November 2013 | Last modified: 17 November 2014

Jenni Johnson
Manager, Pain Management Network
02 9464 4636