{"id":448,"date":"2018-11-13T15:56:15","date_gmt":"2018-11-13T15:56:15","guid":{"rendered":"http:\/\/jarofjam.co.uk\/clients\/nca\/?page_id=448"},"modified":"2024-04-16T06:51:54","modified_gmt":"2024-04-16T05:51:54","slug":"two-week-wait-referral-forms","status":"publish","type":"page","link":"https:\/\/northerncanceralliance.nhs.uk\/pathway\/early-diagnosis\/supporting-primary-care\/two-week-wait-referral-forms\/","title":{"rendered":"Fast Track Suspected Cancer Referral Forms including Dental"},"content":{"rendered":"

Dental Fast track Suspected Cancer Referral Form<\/h3>\n

The form below can be downloaded and used as a fillable form.\u00a0 A Word version of this document has been circulated out to individual practices.<\/p>\n

Please contact the Alliance for any queries: england.nca@nhs.net<\/a><\/p>\n

Dental Fast Track Suspected Cancer Referral Form for Head and Neck Cancer<\/a><\/p>\n

Please use these contact details for GDP suspected head and neck cancer referrals:<\/p>\n

Contact details for GDP Suspected Head and Neck Cancer Referrals<\/a><\/p>\n

Fast track Suspected Cancer Referral Form – Medical<\/strong><\/h3>\n

The forms are in line with the NICE guidance NG12: Suspected Cancer Recognition and Referral. They have been developed to be used as integrated forms in EMIS Web and System One GP clinical systems.<\/p>\n

The forms have been designed to optimise the clinical information in the referral to support the safe and effective care of people being referred to hospital for investigations for suspected cancer.<\/p>\n

Most people referred to hospital in this way do not have cancer.<\/p>\n

Please use the documents here to check you are using the most up to date Fast Track Suspected Cancer forms. All forms should be completed in the clinical system even if the form has to be emailed.<\/p>\n

Fast Track Suspected Cancer Referral Forms & Contact Lists – <\/strong>Latest Version (May 2023)<\/h3>\n
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  1. List of contacts <\/a>for each trust if the form cannot be sent on the e-referral system.<\/li>\n
  2. List of\u00a0contacts<\/a> for each trust for MUO referrals<\/li>\n
  3. \n

    Fast Track Suspected Cancer Referral Forms <\/strong>(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 below. Complete information required before sending referrals<\/strong><\/span><\/h4>\n
      \n
    1. BREAST<\/a><\/li>\n
    2. BRAIN CNS<\/a><\/li>\n
    3. GYNAECOLOGY<\/a><\/li>\n
    4. HAEMATOLOGY<\/a><\/li>\n
    5. HEAD & \u00a0NECK<\/a><\/li>\n
    6. LUNG<\/a><\/li>\n
    7. SARCOMA<\/a><\/li>\n
    8. SKIN<\/a><\/li>\n
    9. THYROID<\/a><\/li>\n
    10. UROLOGY<\/a> – update in progress<\/em><\/li>\n
    11. Malignancy of Undefined Origin<\/a> – update in progress<\/em><\/li>\n
    12. UPPER GI<\/a> – referrals to Gateshead\/South Tyneside & Sunderland\/North Cumbria<\/li>\n
    13. LOWER GI<\/a> – referrals to Gateshead\/South Tyneside & Sunderland\/North Cumbria<\/li>\n
    14. COMBINED PATHWAY (UGI & LGI)<\/a> – referrals to Newcastle\/CDDFT\/Northumbria\/North Tees\/South Tees<\/li>\n
    15. Serious Non Specific Symptoms (NSS)\n