Firstly, we want to thank our patients for their understanding and support as we have worked through our ongoing IT incident. Our staff have worked hard to maintain our services, and to provide care to our communities. We appreciate that the IT outage has resulted in delays and some disruption over the past week, and want to thank everyone involved.

Our focus has understandably been on continued safe and effective care, while NHS England oversaw a thorough and in-depth specialist investigation. This investigation has taken some time but we're pleased that following deep-dive research, there has been no evidence of unauthorised access to patient data.

As a result, we are now gradually and carefully reconnecting some of our priority patient systems, meaning that you should begin to see things return to normal. This will not be immediate and will not apply to all systems at present, so please bear with us as we adjust and reset.

For now, this continues to mean:

• If you are coming to us for a blood test, please make sure you have a paper form. If you do not have a paper form, we cannot do your blood test.
• Unless you are told otherwise, booked appointments are still going ahead as planned.
• If you are due a booked home visit and this has not happened, please call us on 0300 123 3444.

Our staff are working hard to get us back to normal safely and efficiently. Please bear with us, and be kind.

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Respiratory Referral form

Respiratory - Referral form

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You will see a thank you page once the form has been submitted. If you do not see this page then you have overlooked to complete some of the required fields. Please check the form, complete the missing details and resubmit. Thank you.

Diagnosis *Required

Bronchiectasis

Interstitial lung disease (CT report/ consultant letter to prove diagnosis for ILD or Bronchiectasis)

COPD

Emphysema

Spirometry results: Referral will only be accepted with an attachment, with full spirometry results including graphs. *Required

Reason for referral: *Required

Assessment

Follow up from hospital

Pulmonary rehabilitation

Date of referral: *Required

Date / Date of birth

Referred by: (Name/Job Role/Contact No) *Required

Patient details:

Patient name *Required

Patient address: *Required

Post code: *Required

Contact number: *Required

Date of birth *Required

Date / Date of birth

NHS number: *Required

Patient email: *Required

Patient Next Of Kin (name and contact number): *Required

Patient lives:

Alone

Partner

Relative

Warden

Nursing home

Patient has consented to referral: *Required

Yes

GP details:

GP name: *Required

GP address and post code: *Required

Patient medical history

Current reason for referral *Required

Oxygen? *Required

Yes

Please give details (i.e Cylinders / Concentrator / Usage)

Current Spo2 levels (%) *Required

Smoking history? *Required

Yes

Please give further information (i.e Ex smoker/ Cigarettes per day etc)

Age started:

Age stopped/current:

Pack history:

Is Patient Housebound? (i.e. any known risk to area and any history of patient/relative/person at property being aggressive, being under the influence of drink or drugs or refusing treatment) *Required

I agree to the privacy policy