Speech & Language Community - Adult Services

Magnolia Therapy Unit

St Michael’s Site, Gater Drive, Chase Side, Enfield, EN2 0JB.

Tel: 020 8702 5660 Fax: 020 8702 5661

PATIENT DETAILS / REFERRER DETAILS
Forename:
Surname:
Tel:
DOB
NHS number:
Address:
Interpreter required?
Language spoken:
NOK/CARER:
Tel: / Name:
Designation:
Signature:
Location:
Tel No:
REFERRAL DETAILS
Diagnosis and relevant medical history
Is there a history of chest infections?
Reason for referral
Is this patient under the ongoing care of a hospital consultant?
□ Yes (please refer to ECS referral criteria) □ No (please attach copy of consultant discharge report)
Aims of community input
Patients Mobility:
□ Requires Home Visit □ Able to attend as an outpatient □ Transport required
Any known risks/alerts identified for lone worker visits? □ yes □ No
GP Name: Address:
Phone No:Fax No:
Print Name of Referrer: ______Date of Referral:______
Please attach all relevant reports. Please note if there is not enough information provided the processing of this referral will be delayed and the referral may be returned for more information.

Quick guidelines for referring to the Community SLT team

We provide assessment, treatment and management of patients with acquired communication (speech, language, voice) and swallowing difficulties

All patients referred must have clear and realistic aims for community input.

Inappropriate Referrals:-

We will not see:

  • Patients who have been discharged from hospital after a long period of rehabilitation with very little progress made e.g. patients with no potential for change following previous SLT input
  • Patients who have been discharged from hospital and have been managing their recommendations, are stable and have not exhibited any change or do not have rehabilitation potential but are referred “just to check”
  • Patients for whom amulti-disciplinary teamdecision has been made to risk feed with the acknowledged risk of aspiration.
  • Patients referred for monitoring of long term conditions
  • Patients who are not registered to Enfield GPs

Created 7.6.11 S:\SLT REFERRAL FORMS AND REFERRAL CRTIERIA\new referral form.doc