Gateway Documents – GP Gateway

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Also available on the PCIT Referral Tree

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2 Week Waits

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2WW Brain & CNS referral form – blank

2WW Brain & CNS referral form - blank

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2WW Brain & CNS referral form – EMIS

2WW Brain & CNS referral form - EMIS

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2WW Brain & CNS referral form – Vision

2WW Brain and CNS referral form - Vision

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2WW Breast referral form – blank

2WW Breast referral form - blank

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2WW Breast referral form – EMIS

2WW Breast referral form - EMIS

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2WW Breast referral form – Vision

2WW Breast referral form - Vision

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2WW Coventry & Rugby Lower GI FIT & NSS Referral 2023 Blank

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2WW Coventry & Rugby Lower GI FIT & NSS Referral 2023 EMIS

2WW Coventry & Rugby Lower GI FIT & NSS Referral 2023 EMIS

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2WW GI Upper & Jaundice referral form – blank

2WW GI Upper & Jaundice referral form - blank

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2WW GI Upper & Jaundice referral form – EMIS

2WW GI Upper & Jaundice referral form - EMIS

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2WW GI Upper & Jaundice referral form – Vision

2WW GI Upper & Jaundice referral form - Vision

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2WW Gynaecology Referral Form EMIS August 2023

2WW Gynaecology referral form - EMIS

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2WW Haematology referral form – Vision

2WW Haematology referral form - Vision

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2WW Head & Neck Referral Form – Blank 2023 Age Modified

2WW Head and Neck referral form - blank

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2WW Head & Neck Referral Form – EMIS Age Mod 2023

2WW Head and Neck referral form - EMIS

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2WW Lung Referral Form – Blank 2022

2WW Lung referral form - blank

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2WW Lung referral form – EMIS 2022

2WW Lung referral form - EMIS

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2WW Lung referral form – Vision

2WW Lung referral form - Vision

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2WW Non Specific Symptoms Pathway Systemwide EMIS Jan 2024

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2WW Non Specific Symptoms Pathway Systemwide Jan 2024 Blank

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2WW Non-Specific Symptoms Pathway South Warwickshire Blank Oct 23

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2WW Non-Specific Symptoms Pathway South Warwickshire EMIS Oct 23

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2WW Ophthalmology Referral Form – Blank

2WW Ophthalmology referral form – blank

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2WW Ophthalmology referral form – EMIS

2WW Ophthalmology referral form – EMIS

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2WW Ophthalmology referral form – Vision

2WW Ophthalmology referral form – Vision

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2WW Orthopaedics referral form – EMIS

2WW Orthopaedics Referral Form – EMIS Age Mod 2023

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2WW Orthopaedics sarcoma referral form 2024 EMIS

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2WW Orthopaedics Sarcoma Referral Form Age Mod– Blank 2024

2WW Orthopaedics referral form – blank

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2WW Paediatric and Adolescent Referral Form – EMIS 2022

2WW Paediatrics referral form – EMIS

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2WW Paediatrics referral form – Vision

2WW Paediatrics referral form – Vision

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2WW Paediatrics Referral Form 2022 – Blank

2WW Paediatrics referral form – blank

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2WW Skin referral form – Vision

2WW Skin referral form – Vision

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2WW Urology Referral Form – Blank 2022

2WW Urology Referral Form – blank. Updated August 2022

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2WW Urology Referral Form – EMIS 2022

2WW Urology Referral Form – EMIS 2022

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A to E

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AAA Screening Card

AAA Patient Screening Card

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Abdominal aortic aneurysm screening overview

Abdominal aortic aneurysm screening overview

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Abnormal Uterine Bleeding Referral Pathway

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Acute Kidney Injury (AKI) Additional Resources

Resource references for Acute Kidney Injury (AKI)

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Admiral Nurse referral form blank

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Admiral Nurse Self Referral 2024

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Admiral Nurse- Referral Form- EMIS

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Adult ADHD Additional Patient Information 2025

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Adult ADHD Referral Guidance 2025

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Adult ADHD Self-Report Scale ASRS-v1.1

Adult ADHD Self Report Scale Form

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Adult Community ME / CFS & Long Covid Referral Form ISPA

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Adult Grommets / Myringotomy Prior Approval Referral Form Adults Blank 2024

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Adult Neurodevelopment Services Contacts

Adult Neurodevelopment Services Key Contact List

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Adult Neurodevelopmental Service Pathway

Adult Neurodevelopment Service Pathways

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Alzheimers Online Referral Guide

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Ambulatory ECG Referral form – EMIS

Ambulatory ECG Referral form - EMIS

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Ambulatory Pleural Clinic Referral Form 2025

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Anticoagulation Card for DOACs

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AQ10 Autism Referral Form

AQ10 Autistic Spectrum Disorder Referral Form

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Artificial Eye Referral Form

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Autism Additional Patient Information 2025

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Autism Referral form – Children

Autism Referral form - Children

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Autism Referral Guidance 2025

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B12 and Folate testing, indications and GPA and INF tests information

B12 and Folate testing, indications and GPA and INF tests information

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Back pain – red flags information

Back pain - red flags information

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BACPR Excercise protocol

BACPR Excercise protocol

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BCG Referral Guide and Referral Form

BCG Referral Guide and Referral Form

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Be Active Be Healthy GP referral form

Be Active Be Healthy GP referral form

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Be Active Be Healthy self referral form

Be Active Be Healthy self referral form

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Bereavement Point

Information Leaflet

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Bladder & Bowel Care Referral Blank CYP 2025

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Bladder & Incontinence Problems in Women

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Booking an Urgent GP Blood Test May 2024 Pathway

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BPAS Referral Form – Vision

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BPAS Referral Form- EMIS

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Breast Ironing briefing

Breast Ironing briefing

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Breast Pain Pathway

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Breathlessness Pathway December 2023 EMIS

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Bunions

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C&W Guide to Unscheduled Bleeding on HRT

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Carbs 4 1 – Type 1 Diabetes Education

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Care of feet for diabetics

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Carers forms

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Carers referral form – blank

Carers referral form - blank

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Carers referral form – EMIS

Carers referral form - EMIS

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Carers Trust Heart of England Referral Form

Carers Trust Heart of England Referral Form (Coventry)

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Caring for patients & families with Sepsis

Support materials for sepsis patients

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CG051 Management of Menopause Nov 25

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CGL Coventry Referral Form 2022

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CGL Coventry Referral Form EMIS 2022

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CGL Warwickshire referral form

CGL Warwickshire referral form

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CGL Warwickshire Referral Form EMIS

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Checklist for At Risk Mental State

Checklist for At Risk Mental State

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CHESS referral form – Vision

CHESS referral form - Vision

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CHESS referral form blank

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CHESS referral form EMIS

CHESS referral form - EMIS

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Chest pain – instructions for using Choose and Book

Chest pain - instructions for using Choose and Book

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Chest Pain explanatory notes

Chest Pain explanatory notes

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Chest pain referral forms – Cardiac – blank

Chest pain referral forms - Cardiac - blank

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Chest pain referral forms – Cardiac – Vision

Chest pain referral forms - Cardiac - Vision

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Chest pain referral forms – Cardiac – EMIS

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Child Development Service referral form – SPA – Rugby

Child Development Service referral form - SPA - Rugby

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Child Developmental service – Information required on referral form – Rugby

Child Developmental service - Information required on referral form

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Child protection forms

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Child protection forms – Warwickshire – blank

Child protection forms - Warwickshire - blank

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Children & Young People’s Physiotherapy (Warwickshire) EMIS Referral form (also available on PCIT Referral Tree)

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Children & Young People’s Physiotherapy (Warwickshire) Referral Form blank (Also available on PCIT Referral Tree)

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Children and Young People’s Mental Health One Front Door – Referral Form 2026 Also available on PCIT Referral Tree

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Children and Young People’s Mental Health One Front Door – Referral Form EMIS 2026 Also available on PCIT Referral Tree

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Children’s Occupational Therapy (OT) Services – Rugby

Children's Occupational Therapy (OT) Services

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Children’s Respiratory Physio Referral (CYP)

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Childrens Respiratory Physio Referral EMIS (CYP)

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Choose to Change Referral (C2C)

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Clinical Genetics Development Form2022

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Clinical Genetics Family History Form 2022

Family history form for patients to accompany appointment or referral

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Community AF Service Referral Form Blank

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Community AF Service Referral Form EMIS

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Community Dental Referral Form EMIS 2023

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Community Dental Service Referral Form v2023

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Community dermatology referral form v2 2024 BLANK

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Community dermatology referral form v2 2024 EMIS

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Community eating disorder referral form 2024 blank

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Community eating disorder referral form 2024 EMIS

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Community LD New Referral for Jan 26

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Community Nursing & Therapy Referral Form Blank 2025 also available on PCIT Referral Tree

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Community paediatric physiotherapy

Community paediatric physiotherapy

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Community Paediatrics Information

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Community Spirometry Referral Form GEH

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Complex Physical Health Needs MDT Referral Form PDF Blank v8 2025

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ConnectWELL – how to refer

ConnectWELL - how to refer

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ConnectWell introduction

ConnectWell introduction

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Consanguinous Relationships – Discussion Notes

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Consensus on the Primary and Secondary Care Interface 2024

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Consultant-led Specialist Community Diabetes Service – SCDS

Pathway and details about the consultant led specialist service in diabetes

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Continence Service Referral Form – Rugby

Continence Service Referral Form - Rugby

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Continence Services information – SWFT

Continence Services information - SWFT

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COPD – Guidance from Area Prescribing Committee

COPD - Guidance from Area Prescribing Committee

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COPD – Pulmonary Rehab Patient Information

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CORA Health NOUS Blank Referral Form

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Coventry & Warwickshire Primary Care Strategy

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Coventry Carers Referral Form Blank

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Coventry Community Palliative Care Referral Form Blank 2025

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Coventry Community Palliative Care Referral Form EMIS 2025 Available on PCIT Referral Tree

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Coventry Continence Referral Form

Continence Services referral form (Coventry)

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Coventry Falls Physiotherapy Service information

Coventry Falls Physiotherapy Service information

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Coventry Falls Physiotherapy Service patient leaflet

Coventry Falls Physiotherapy Service patient leaflet

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Coventry MacMillan Dietician

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Coventry MSK Physiotherapy Service list of available injections

Coventry MSK Physiotherapy Service list of available injections

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Coventry Refugee & Migrant Referral Form Blank

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Coventry Safe Haven Leaflet

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Coventry School Health & Wellbeing Referral Form 2024

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COVID Oximetry@home EMIS Merged Referral Form

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COVID Oximetry@home Referral Form

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COVID@home EMIS Booking

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Criteria For Referral For Multi Disciplinary Assessment By Child Development Service – Rugby

Criteria For Referral For Multi Disciplinary Assessment By Child Development Service

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Cryopreservation of Gametes Oncology Referral (intended for secondary care use) 2024

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CW ICB Individual Funding Requests Policy June2024 update March 2026

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CWICB Adult ADHD Commissioning Policy 2025

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CWICB Policy for Primary Hip and Knee Replacement Surgery (with or without Patella Replacement or Resurfacing) 2025

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CWPT Coventry Children’s Physiotherapy Referral Form 2024

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CYP Childrens and Young People Asthma Pathway Referral

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CYP Long COVID Referral Form

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Death Audit Template

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Dementia – Admiral Nurses – information leaflet

Dementia - Admiral Nurses - information leaflet

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Dementia Active Referral Form 2022

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Dementia Navigator Referral Form – EMIS

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Dementia Navigator Referral Form- Vision

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Department of Health PIP implants report

Department of Health PIP implants report

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Desmond – Type 2

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DESMOND Leaflet

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DESMOND Referral Form Blank 2022

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DESMOND Referral Form EMIS 2022

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DEXA referral form – Rugby – blank

DEXA Scan referral forms - Rugby - blank

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DEXA referral form – Rugby – EMIS

DEXA Scan referral forms - Rugby - EMIS

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DEXA referral form – Rugby – Vision

DEXA Scan referral forms - Rugby - Vision

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Diabetes – Healthy Eating With Diabetes (Type 1&2) UHCW

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Diabetes – Pre Diabetes information

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Diabetes – Type 2 information

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Diabetes: How to take control (UHCW Dept Nutrition & Dietetics)

Diet and lifestyle advice for patients with Type 2 diabetes

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Diabetic Foot Referral Form George Eliot (Blank)

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Diabetic Foot Referral Form George Eliot (EMIS)

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Diabetic Foot Referral Pathway – Rugby

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Diabetic Foot Screening Checklist

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Diabetic macular oedema referral form – blank

Diabetic macular oedema referral form - blank

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Diabetic macular oedema referral form – EMIS

Diabetic macular oedema referral form - EMIS

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Diabetic macular oedema referral form – Vision

Diabetic macular oedema referral form - Vision

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Direct Access Echocardiography Blank

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Direct Access Echocardiography EMIS

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Direct Oral Anticoagulation for Non-Valvular Atrial Fibrillation in Adults(aged ≥18 years)Guidance

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Domestic Violence Referral

Coventry Haven Referral Form

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Dupuytrens Disease Surgery VISION

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DVT Pathway

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Dyspepsia – NICE Quick Reference Guide

Dyspepsia - NICE Quick Reference Guide

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Early Arthritis Clinic Blank Referral Form 2022

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Early Arthritis Clinic Referral Form- EMIS 2022

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Early Help Referral Form

Includes Troubled Family Criteria Guidance

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East Midlands Gambling Harms Service

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Eating well with diabetes

Dietary guidance for diabetes

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Eating well with diabetes (Polish version)

Dietary advice in diabetes (Polish version)

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Edit List of Patient Resources

Follow this link to add your own favourite patient website / leaflet link for other GPs to share

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Emergency Eye Appointments Booking Information

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EMIS DOAC Template

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EOL Appendix 6C

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EOL Service Specification

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EUROPAC Referral Form

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Exercise forms

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Eye Casualty Patient Leaflet

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Eye Casualty Referral Form

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Faecal Calprotectin Guidelines GPG15 (2024)

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Familial Hypercholesterolaemia Referral Form 2022(blank)

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Familial Hypercholesterolaemia Referral Form- EMIS

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Fertility Preservation Sperm Storage Form

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Fever in children traffic light chart

Fever in children traffic light chart

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FGM Training Package for NHS Organisations

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Final Full FeNO Service Specifications

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Fire Safety check – Referral Form

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FIT Demonstration Kit Request for Primary Care 2023

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FIT Patient Leaflet Reviewed 2024

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FIT Request Form – Thrombocytosis 2022 – EMIS

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FIT Request Form 2023 inc Lower GI Pathway – Blank

FIT Request Form 2022 - Blank

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FIT symptomatic pathway using NICE low risk guidance

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Fitter Future Information

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Fitter Futures Referral 2019

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Flat feet in Children

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Foot and Ankle Pathway – Rugby

Foot and Ankle Pathway - Rugby

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Footwear advice

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Footwear advice for diabetics

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Gaining consent in Reviews

Gaining consent in Reviews

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GCA Pathway November 2023

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George Eliot Tongue Tie Referral

Tongue tie referral form

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Geriatrician Led Falls Clinic information

Geriatrician Led Falls Clinic information

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Gestational Diabetes RCOG Patient Leaflet

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Global Diagnostics form referral form – blank

Global Diagnostics form referral form - blank

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Global Diagnostics form referral form – Vision

Global Diagnostics form referral form - Vision

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GLP1 Receptor Agonist Patient Leaflet

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Good foot guide

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Good Hoof Guide

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GP Advice Line Referral Form (also available on PCIT Referral Tree)

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GP Exercise Referral Form

GP Exercise Referral Form

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GP Guidance – Continuing Healthcare

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GP Liaison Compliment Slip 2024

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GP Liaison Nurse referral form – blank

GP Liaison Nurse referral form - blank

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GP Liaison Nurse referral form – EMIS

GP Liaison Nurse referral form - EMIS

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GP Liaison Nurse referral form – Vision

GP Liaison Nurse referral form - Vision

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GP Liaison Patient Leaflet 2024

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GP Liaison Service Contact Details

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GP Referrals to Eye Casualty UHCW

Eye Casualty contact details for Primary Care

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GP Report to Coventry Coroner – Blank

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GP Report to Coventry Coroner – EMIS

Death report to HM Coroner by GP - EMIS

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GP Safeguarding Claims Template

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GP weekly rota

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Guidance for health professionals on the Assessment of Mental Capacity

Guidance for health professionals on the Assessment of Mental Capacity.

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Guidance for Women on Tamoxifen / Investigations for Endometrial Abnormality on Scan

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Guidance for Women on Tamoxifen and Investigations for Endometrial Abnormality on Scan

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Guidance on Vitamin D testing

Guidance on Vitamin D testing

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Guide to adult musculo-skeletal (MSK) physiotherapy services – Coventry

Quick reference guide Adult (iMSK) physiotherapy - Coventry

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Haematology Urgent Suspected Cancer (2WW) Referral EMIS October 2025 Also available on PCIT Referral Tree

Haematology USC 2WW referral form - EMIS

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Haematology Urgent Suspected Cancer (2WW) Referral Blank October 2025 Also available on PCIT Referral Tree

2WW Haematology referral form - blank

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Haemoglobinopathy Screening Flowchart

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Haemoglobinopathy screening information

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Hallux Valgus – Bunions Referral – EMIS 2021

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Hallux Valgus Policy December 2023

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Hallux Valgus Referral Form Blank 2021

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Headache Quick Reference Guide

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Healthwise referral EMIS – also available PCIT Referral Tree

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Healthwise Referral Form Blank – also available on PCIT Referral Tree

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Healthy Eating for Patents with CKD 1 2 3

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Healthy Lifestyles – Form (for merging)

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Healthy Lifestyles – Form (manual input)

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Heart failure – Causes of falsely positive and falsely negative BNP

Heart failure - Causes of falsely positive and falsely negative BNP

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Heart failure – Coventry Guidelines on Medical Therapy for HF

Heart failure - Coventry Guidelines on Medical Therapy for HF

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Heart Failure – Titration Schedule

Heart Failure - Titration Schedule

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Heart Failure Rehabilitation Referral Form (Coventry)

Heart failure rehabilitation

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Heart Failure Rehabilitation Referral Form (Coventry)- EMIS

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Heart Failure Rehabilitation Referral Form (Rugby)

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Heart Failure Suspected Referral Form 2024

Updated referral form for heart failure

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High Blood Pressure – Hypertension Leaflet

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Hoarding Service Referral Form

Hoarding services referral form

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Hoarseness – patients advice on voice care

Hoarseness - patients advice on voice care

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Home Oxygen Assessment and Review Form (HOS-AR) George Eliot Hospital

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Home Oxygen Assessment and Review Form (HOS-AR) UHCW Coventry

Home Oxygen Assessment and Review referral form

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Home Oxygen Order Form A (HOOF A)

Home Oxygen Order Form (HOOF A)

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How to collect a poo sample for FIT testing

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How to Import Documents to EMIS

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How to Remove Documents from EMIS

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How we deliver oxygen therapy at home(pdf)

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HSC1 forms

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Hyperhidrosis policy December 2023

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Hyperkalaemia Algorithm

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Hypernatraemia Algorithm

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Hypokalaemia Algorithm

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Hyponatraemia Algorithm

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Individual Funding Request Patient Leaflet CWICB 2024

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Individual Funding Request Proforma Blank 2024-25

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Infectious Disease Referrals

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Inflammatory Back Pain Referral EMIS 2022

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Inflammatory Back Pain Referral Form Blank

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Information and Advice for Neurodivergent People and their Families v2 2023

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Information for People Thinking of Having Laparoscopic Weight Loss Surgery

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Informing Resuscitation Choices – Patient Information Leaflet

About Resuscitation - Patient Information Leaflet

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Inhalers for COPD – NICE guidance

Inhalers for COPD - NICE guidance

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Instructions for Formatting NDPP Referral Form 2024

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INT – GP Information leaflet

INT - GP Information leaflet

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INT – Information for patients leaflet

INT - Information for patients leaflet

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INT – Pathway

INT - Pathway

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INT Referral criteria

INT Referral criteria

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INT Referral form – Blank

INT Referral form - Blank

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INT Referral Form – Vision

INT Referral Form - Vision

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Intoeing

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Intra-ocular pressure opticians

Intra-ocular pressure opticians

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Investigation and management of B12 Folate deficiency

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Irritable Bowel Syndrome – Pre-Referral Investigations Flow Chart

Irritable bowel syndrome - pre-referral investigations flow chart

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It Could be Long Covid Toolkit

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Joint & Soft Tissue Injections performed (and not) by MSK Physio Service at City of Coventry Health Centre

Coventry MSK Physiotherapy Service list of available injections

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Kidney stones dietary recommendations

Kidney stones dietary recommendations

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Learning Disabilities GP Resource Pack 2025

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Learning Disabilities Referral Form EMIS 2026

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Learning Disabilities Referral Form EMIS 2026

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Learning Disabilities Referral Form Jan 2026 (Blank)

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Letter to GPs with READ codes

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LGBT+ Resources

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Living Well Project – Referral Form

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Long term oxygen therapy

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Low Priority Procedure forms

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Lower urinary tract symptoms frequency/volume chart

Lower urinary tract symptoms frequency/volume chart

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Lower urinary tract symptoms patient questionnaire

Lower urinary tract symptoms patient questionnaire

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LPP Carpal Tunnel Referral Blank 2021

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LPP Grommets & Myringotomy (Adults) Blank 2021

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LPP Grommets & Myringotomy (Adults) EMIS 2021

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LPP Grommets and Myringotomy Blank 2021

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LPP Hernia Repair Blank 2022

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LPP Hernia Repair Surgery – EMIS 2022

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LPP Referral Form – Ganglion Treatment – Vision

LPP Referral Form - Ganglion Treatment - Vision

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LPP Referral Form – Grommets & Myringotomy – Vision

LPP Referral Form - Grommets & Myringotomy - Vision

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LPP Referral Form – Tonsillectomy & Adenotonsillectomy – Vision

LPP Referral Form - Tonsillectomy & Adenotonsillectomy - Vision

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LPP Referral Form – Trigger Finger Release Surgery – Vision

LPP Referral Form - Trigger Finger Release Surgery - Vision

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LPP Referral Form Carpal Tunnel EMIS 2021

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LPP Referral Form Tonsillectomy Adenotonsillectomy EMIS 2022

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LPP Referral Form Trigger Finger Release Surgery EMIS 2021

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LPP Referral form- Grommets_Myringotomy- EMIS

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LPP Tonsillectomy Blank 2022

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LPP Trigger Finger Blank 2021

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Management of lower urinary tract symptoms in men flow-chart

Management of lower urinary tract symptoms in men flow-chart

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Management of Sharps & Needlestick Injuries

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Management of Sharps Exposures in the Community

Management of Sharps Exposures in the Community

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Management of Sharps Injuries in the Community

Management of Sharps Injuries in the Community

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MDT Vulnerable Family Meetings Attendance Sheet

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MDTNSP Service Specification

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Medical Examiner Referral Form blank 2024

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Medical Examiner Referral Form EMIS 2024

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Mental health adult SPE forms

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Mental Health Referral EMIS 2022

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Mental Health Referral Form Blank 2022

Mental Health Referral Form updated 2022

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MenTalk Referral Form 2022 amended

New email address

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MoCA Assessment Form

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Monkeypox Toolkit June 2022

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Mortons Neuroma

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MSK Patient Leaflet 2024

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Myton Counselling Referral Form

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Myton Hospice General Referral Form

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Myton Hospice Lymphoedema Clinic Referral Form

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NASA Lean Test NHS Highland

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Neurology referral guidance

Neurology referral guidance

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NHS Blood tests leaflet

How to book an appointment for a blood test locally

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NHS Diabetes Prevention Programme 2025 EMIS referral dropdowns

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NHS Diabetes Prevention Programme Blank 2024 referral dropdowns

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NHS Eye Care Centre locations and operating times

NHS Eye Care Centre locations and operating times

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NHS Eye Care Services conditions for Tier 2

NHS Eye Care Services conditions for Tier 2

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NHS Eye Care Services signposting guide

NHS Eye Care Services signposting guide

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NHS Hearing Care Service Leaflet

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Non Invasive Vasectomy referral form – EMIS

Non Invasive Vasectomy referral form - EMIS

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Non Invasive Vasectomy referral form – Vision

Non Invasive Vasectomy referral form - Vision

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Non Specific Symptoms Pathway Referral Form August 2023 Blank

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Non Specific Symptoms Pathway Referral Form EMIS August 2023

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North Warwickshire CDC Breathlessness Pathway Blank Referral 2023

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North Warwickshire CDC: C&YP Asthma Referral Form Blank 2025

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Notification Cover Sheet Example

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Nuneaton Safe Haven Leaflet

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Nurse Led Bed Referral Form

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Nutrition – Cook and Eat Well service leaflet

Nutrition – Cook and Eat Well service leaflet

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Occupational Therapy Form (Coventry)

OT referral sheet Coventry

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OneLTC Diabetes (TM0

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Open or Upright MRI Scan Prior Approval Form

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Opiate Naive Exemplar Prescribing EGFR <30

A guide to opiate prescribing - simulated examples

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Opiate Naive Exemplar Prescribing EGFR >30

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Opioid Pain Killers & Chronic Pain Management

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Opioid Patient Leaflet

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Opthalmic Survival Manual

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Ordering of home oxygen guidance

Ordering of home oxygen guidance

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Paediatric Allergy Presentation

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Paediatric Allergy Team Information October 2019

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Paediatric Dysphagia Service overview

Paediatric Dysphagia Service overview

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Paediatric Eczema Care Plan blank

A personalised care plan for the management of paediatric eczema

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Paediatric Eczema Care Plan EMIS

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Paediatric orthopaedic physiotherapy – UHCW

Paediatric orthopaedic physiotherapy - UHCW

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Paediatric Orthopaedics Urgent Referral Form

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Pain Clinic

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Pain Clinic referral form – EMIS

Pain Clinic referral form - EMIS

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Paramedics Acute Visiting Service EMIS Form

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Paramedics Acute Visiting Service Vision Form

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Paraprotein Results guidance

Paraprotein Results guidance

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Patient Information Leaflet

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Patient Information Post Vasectomy Semen Analysis

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Patient pathway for Management of absent IUD

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Patient Removal Request Form (Immediate and 8 day) Blank

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PAVs Referral Process

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Peer Mentoring Referral Form PMSS

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Pelvic Floor Exercises SWFT

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Penile Implant Commissioning Policy

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Perinatal Mental Health Referral Form with Core 10 v2 mod 2024

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Pharmacological management of chronic pain guidelines – UHCW

Pharmacological management of chronic pain guidelines - UHCW

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Physiotherapy Adult Learning Disability referral form – blank

Physiotherapy Adult Learning Disability referral form - blank

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Physiotherapy referral from – Rugby

Physiotherapy referral from - Rugby

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PIP breast implants local policy

PIP breast implants local policy

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Plantar Fasciitis

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PML Referral Form EMIS

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PMS Bid Scheme Process

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PMS Premium End of Life Care

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PMS Premium EOL Care

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PMS Safeguarding Information Sharing Training for Practices

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Policy for Complex and Specialised Obesity Surgery CWICB June 2024

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Policy for Varicose Vein Intervention CWICB 2024

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Post COVID Referral Form Blank

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Post COVID Referral Form EMIS

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Post Covid Referral SWFT Blank

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Post Covid Referral SWFT EMIS

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Post Operative Wound Care After Joint Replacement

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Poster for surgery – Autism

Autism publicity poster

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Poster for Surgery – Autism & ADHD

Autism & ADHD publicity poster

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Preventing Acute Kidney Injuries – Patient Leaflet 2023

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Preventing AKI’s Patient Leaflet 2023

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Primary Care Dermatology Service Blank 2025

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Primary Care Dermatology Service EMIS 2025

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Primary Care Surge Request Form October 2024

Primary Care Surge Request Form

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Prior approval for Hip Pain – GP information leaflet

Prior approval for Hip Pain - GP information leaflet

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Prior approval for Hip replacement surgery – Vision

Prior approval for Hip replacement surgery - Vision

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Prior Approval Referral Form Varicose Veins Surgery 2021 EMIS

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Prolapse Leaflet

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Psychiatry Advice Line EMIS Referral Form 2026 Also available on PCIT Referral Tree

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Psychological Support for Those With Cancer Blank 2023

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Psychosis Checklist

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Pulmonary Rehab Coventry Referral form EMIS 2024

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Pyrexia of Unknown Origin

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Referral form for Dementia Nurses – Coventry & Rugby

Referral form for Dementia Nurses - Coventry & Rugby

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Referral guidance on head and neck lumps

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Referral Guidelines for Specific Foot & Ankle Conditions – Rugby

Referral Guidelines for Specific Foot & Ankle Conditions - Rugby

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Referral Pathway for abnormal head shape

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Refugee Wellbeing Referral C&W All ages

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Rejection Letter Patient and MP

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Rejection Letter Specialist

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Renal Dietician

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ReSPECT Form v3

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Respiratory Breathlessness Referral Rugby and Warwickshire CDC

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Respiratory Diagnostics Referral Rugby and Warwickshire CDC

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Respiratory Physiotherapy Outpatient Services GEH 2023

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Respiratory@home (Virtual Ward) Patient Pack Nov 2023

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Respiratory@Home Referral Form Blank 2025

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Respiratory@Home Referral Form EMIS 2024

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Retinal vein occlusion referral form – blank

Retinal vein occlusion referral form - blank

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Retinal vein occlusion referral form – Vision

Retinal vein occlusion referral form - Vision

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Retinal vein occlusion referral form – Emis

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Rhinoplasty Septorhinoplasty Septoplasty Referral Form EMIS 2021

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RSS generic referral forms - blank

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RSS generic referral forms - EMIS

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RSS generic referral forms - Vision

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RSS Patient leaflet

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Rugby – Podiatry services information

Rugby - Podiatry services information

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Rugby School Health & Wellbeing Referral Form (Compass)

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Safe Haven Flier 2024

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Safe Haven Leamington

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Samaritans Referral

Referral using attached form

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Sample Managing Breath

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Sample Post covid breath control

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School nurses form

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Secondary Care Prior Approval for Primary Hip and Knee Replacement Surgery (with or without Patella Replacement or Resurfacing) 2025

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Secondary Care Workload Letter Blank

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Secondary Care Workload Letter EMIS

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Self Referral Background Information (Coventry)

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Sepsis Guidelines

Guidelines and assessment tools for Sepsis

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SGLT2 inhibitor medicines for heart failure – patient leaflet

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SGLT2 Inhibitors Patient Leaflet

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SHARING IMAGE Request Form (Blank)

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Sip feed guidelines (MUST)

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Skin 2WW Blank

Summary for Skin 2WW Blank

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Skin2WW EMIS

Skin2WW EMIS summary

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Sleep Pathway Rugby (OSA only) and Warwickshire CDC (all sleep)

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Smoking harm reduction – CW Mind Referral form

Smoking harm reduction – CW Mind Referral form

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Smoking harm reduction – CW Mind Service leaflet

Smoking harm reduction – CW Mind Service leaflet

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South Warwickshire Community Specialist Pallliative Care Services- Referral form- EMIS

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Specialist Dietetic Service for Adults

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Specialist Palliative Care Team SPCT Referral Pathway 2022

Specialist Palliative Care Team - Referral Pathway

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Specialist Weight Management Service

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Specific foot and ankle conditions information

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Specific IgE Testing

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Speech and language referral form - adults - blank

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Speech & Language Referral Form (Adults) Coventry EMIS 2023

Speech and language referral form - adults - EMIS

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Speech & Language SALT Referral Communication Coventry (Children)

Speech and language referral form - children - Coventry

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Speech & Language SALT Swallowing & Dysphagia Referral Coventry (Children)

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Speech and language referral form – children – Rugby

Speech and language referral form - children - Rugby

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Speech and language referral form - pre-school - Rugby

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Speech and Language Therapy Service referral information – Rugby

Speech and Language Therapy Service referral information - Rugby

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Squint pre-school referral process

Squint pre-school referral process

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St Giles Hospice Lymphoedema Clinic Referral Form

Referral Form

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Stool Samples Collection guidance

Stool Samples Collection guidance

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Stopping oxygen therapy at home (pdf)

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Stroke Services Referral Form 2024

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T2 Diabetes EMIS Searches XML

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T2 Diabetes Path to Remission Commissioning Documents

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T2DR Referral Blank (no flowchart)

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T2DR Referral EMIS (flowchart)

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T2DR Referral EMIS flowchart included 2025 (available on PCIT Referral Tree)

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T2DR Referral EMIS no flowchart 2025 (available on PCIT Referral Tree)

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Talking Therapies referral form 2024 GP ONLY (EMIS)

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Teledermatology Patient Information Jan 2024

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The Good Sleep Guide

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Thrombophilia Guidelines

Guidelines for Thrombophilia Referral and Management

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Thyroid Function Testing Protocol

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TIA Referral Form – EMIS 2024

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Two Week Wait forms

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Type 1 Diabetes Mellitus The 4T’s

Diabetes UK The 4T's poster

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Type 1 DM Group Education Referral Form 2024 inc Carbs 4 1

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Type 1 DM New Diagnosis – Step by Step Referral Form 2024

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Type 2 Diabetes Treatment Algorithm for Glucose Lowering in Adults (Updated 2021)

APC Type 2 Diabetes Algorithm and Links

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UCR Referral Form Blank 2025

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UHCW Domiciliary Phlebotomy Blood Form BLANK 2025

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UHCW Domiciliary Phlebotomy Blood Form EMIS 2025

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UHCW Hospital at Home Heart Failure Pathway Patient Leaflet

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UHCW Map 2024

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UHCW Pathology Directory Coventry and Warwickshire v7 Nov 2025

Pathology Directory, UHCW, Coventry and Warwickshire.

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Ultrasound forms

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Understanding Cataracts

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Urgent Community Response UCR Form June 2022

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Urgent Community Response UCR Referral Form EMIS 2022

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Urgent Direct Access TVS for USB on HRT Request Form Blank November 2025

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Urgent Direct Access TVS for USB on HRT Request Form EMIS November 2025 Also available on PCIT Referral Tree

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Urgent Suspected Cancer (2WW) Skin EMIS Referral Form Feb 2026 (Also available on PCIT Referral Tree)

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Urgent Suspected Cancer Skin (2WW) Referral Form Blank Feb 2026 (Also available on PCIT Referral Tree)

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Urine Flowchart – Suspected UTI

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USC Gynaecology EMIS November 2025 Also available on PCIT Referral Tree

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USC Gynaecology Referral Blank November 2025

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UTI Flowchart RCGP

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Valley House Referral

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Varicose Vein Intervention Prior Approval Referral Form Blank 2024

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Vertigo Quick Reference and Referral Guide

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Warts pathway

Summary for Warts pathway

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Warwickshire Dietician Referral Form

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Warwickshire Dietician Service (Children)

Referral criteria for dietetic advice for children

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Warwickshire School Health & Wellbeing Referral Form (Compass)

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Warwickshire Special Dental Referral v2026

Also available on the PCIT Referral Tree

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Warwickshire Specialist Dental Referral Form (EMIS) v2026 (also available on PCIT Referral Tree)

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Warwickshire Specialist Dental Referral Form (Word) v2026 (also available on PCIT Referral Tree)

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Warwickshire Wheelchair Criteria

Warwickshire Wheelchair Criteria

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Ways to boost food intake

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Well babies with prolonged jaundice

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West Midlands CYPSAS 2024

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West Midlands Family Cancer Strategy (WMFACS) Cancer Family History Form 2022

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West Midlands Paediatric Sexual Assault Centre Professionals Leaflet

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Wheelchair Coventry

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Wheelchair Coventry

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Wheelchair request form – Coventry

Wheelchair request form - Coventry

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Wheelchair service criteria – Coventry

Wheelchair Coventry service criteria

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Wheelchair Service referral Form – Rugby

Wheelchair Service referral Form - Rugby

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WMFHS Referral Form Blank 2022

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WMFS – referral process for GPs

WMFS - referral process for GPs

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WMFS Youth Service Referral Form

WMFS Youth Service Referral Form

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WOMENtalk referral form 2023

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WorkWell Client Leaflet

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Wound swab guidelines

Summarises wound swabs

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Young Black Men’s Mental Health Project Referral

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A 3 page A4 Summary of Wallet Sized Guidance

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