National Referral Form

ICGP Guidance Document for GPs on National Referral Form to Secondary Care

This document presents a new referral letter format, developed by HIQA in collaboration with the Irish College of General Practitioners, as a national standard. It also contains guidance for GPs on how to complete the new referral form.

 Click here to view the Guidance Document

 Click here to view the GP Referral Template

  Click here to view the GP Referral Template

How to Use the Template Referral Form Using...

Four of the GPIT accredited practice management systems (Complete GP, Health One, Helix Practice Manager and Socrates) can produce the national referral form from the patient's file. This enables GPs to use this new format in paper form instead of their current referral letter.


In March 2010, the ICGP GPIT facilitators began the process of improving the generation of referral letters from GP practice management software. They sought to develop a nationally-accepted dataset which would present the information in a standardised format. The referral form developed by the GPIT facilitators and HIQA simplifies and streamlines the referral process for GPs, while improving the quality and consistency of referral data received by hospitals.

HIQA's Report and Recommendations on Patient Referrals from General Practice to Outpatient and Radiology Services, Including the National Standard for Patient Referral Information, released in June 2011, contains the final version of the collaboration of GPIT and HIQA work.

It is envisaged that referrals will be made electronically in the future, similar to the national cancer referral forms that are currently available. This work will support HSE electronic referral projects currently in development.

ICGP Guidelines for Palliative Care Referrals Using the National Referral Form

When completing the referral form to a palliative care service the following additional specific information is required to ensure it is dealt with most efficiently.

  1. Priority of Referrals
    Urgent referral: You feel the patient needs review within 48 hours.
    Routine: Where you feel the patient needs review within 1 to 2 weeks.
  2. Reason for Referral/Anticipated Outcome
    Please also enter an estimation of patient's prognosis in terms of days/weeks/months in this section.
  3. Additional Relevant Information
    Insight: It is of immense value to the palliative care service to know the patients and families awareness of both their diagnosis and of the referral. Please outline this in this section.

The above guidelines have been developed with the HSE Palliative Care Clinical Programme.

ICGP Guidelines for CIPC Counselling Referrals Using the National Referral Form

  1. GMS Number: If this is incorporated into the standardised template under "Patient Details" then this will not be additional, however a valid GMS number is required for a referral to this service
  2.  Mental Health History. As much relevant detail as possible
  3. Confirm Opt In procedure has been explained to patient under "Additional Relevant Information".
    Please give patient leaflet "CIPC Information for Clients" or explain the service and the Opt-in Procedure
  4. For ethical reasons clients who are related are not generally seen by the same Counsellor/Therapist.
    Please specifically enquire and record under "Additional Relevant Information" if another family member or relative has been referred to CIPC?
    Yes/No/Don't know


 Using GPIT Template Referral Form in Complete GP (National_Referral_Template__CompleteGP.pdf | 224 KB)
 Using GPIT Template Referral Form in Health One (Using_GPIT_Template_Referral_Form_in_Health_One.pdf | 172 KB)
 Using GPIT Template Referral Form in Helix Practice Manager (National_Referral_Template__Helix_Practice_Manager.pdf | 333 KB)
 Using GPIT Template Referral Form in Socrates (National_Referral_Template__Socrates.pdf | 364 KB)
 GP Referral Template (GP_Referral_Template.pdf | 38 KB)
 GP Referral Template (National_Referral_Form.doc | 167 KB)
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