Urgent suspected cancer referral forms

Urgent Suspected Cancer Referral Forms & Contact Lists

List of contacts for each trust if the form cannot be sent on the e-referral system.

List of contacts for each trust for MUO referrals

Urgent Suspected Cancer Referral Forms (PDFs) – For Reference Only. DO NOT LOAD THE PDF FORMS INTO ANY CLINCAL SYSTEMS. Please use the forms directly in EMIS and SystmOne following the instructions here. Complete information required before sending referrals.

• Breast
• Brain CNS
• Gynaecology
• Haematology
• Head & Neck
• Lung
• Sarcoma
• Skin
• Thyroid
• Urology
• Malignancy of Unknown Origin
• Upper GI – referrals to Gateshead/South Tyneside & Sunderland/North Cumbria
• Lower GI – referrals to Gateshead/South Tyneside & Sunderland/North Cumbria
• Combined Pathway – UGI & LGI –  referrals to Newcastle/ CDDFT/ Northumbria/North Tees/South Tees

Serious Non Specific Symptoms (NSS)

• CDDFT
• Newcastle
• Northumbria
• North Tees
• South Tees
• North Cumbria

👉 Referral Header Sheet V4b

Information on Cancer Decision Support tools (CDS) can be found 👉  here.