PAEDIATRIC HOT CLINIC REFERRAL FORM	
                            Please see referral  guidance overleaf  for further information 	
                                                                                   PATIENT DETAILS	
First name:                                        Surname:                                                                      DOB:
NHS Number:
Hospital number (if known):
Address:
 Contact Telephone Number (MUST BE PROVIDED):	
                                                                                   REFERRER DETAILS	
Name:
G.P Practice:
Contact Telephone Number:	
Email Address :		
REASON FOR REFERRAL                  Date :                                                        Time:	

Referral received:
Date:
Time:
	Referral triaged: 
Date:            
Time:	Triage instructions:	Appointment offered:
Date:             
Time:	
REFERRAL GUIDANCE	

Service Description: Hot Clinic is a rapid access general paediatric outpatient clinic for children aged 0-16 years who require an urgent paediatric specialist opinion within 5 working days.  It is for children who are not unwell enough to require same day attendance at the Emergency Department or our Ambulatory Unit; (The Blue Sky Centre) but who cannot wait for a routine outpatient appointment.
Venue :  Dragon Children’s Centre, Lanesborough wing, St George’s Hospital, Blackshaw Road, Tooting, London SW17 0QT
Time:  Monday to Friday (excluding Wednesday) 09:30 to 12:30. Five 30 minute appointments available. 
Referral procedure:  GPs to complete this form and email it to the administration team.
EMAIL ADDRESS: stgh-tr.PaediatricRRC@nhs.net
TELEPHONE NUMBER FOR QUERIES:  0208 725 1896
Inclusion criteria: Children who need a senior paediatric opinion within 5 day but are unlikely to need admission.  
Exclusion criteria: Children who require routine outpatient services or who are known to a specialist team with the same problem. Referrals will be re-directed if appropriate eg children with seizures go to the Epilepsy Clinic, those who are more appropriate for our standard general paediatric clinic will be booked into the next available appointment. Children who are seriously unwell and likely to need immediate treatment or hospital admission should be discussed with the paediatric consultant on the “Hot Phone” 07584610052. 
Appointment  procedure:  All referrals will be triaged by a consultant every week day.  If a rapid referral clinic appointment is indicated the parents will be contacted by text message to offer them an appointment.  If the family do not attend within 5 working days then they will be discharged from the service. 
Outcome Clinic Letter:  We aim to send a clinic letter to GPs and parents within 10 days. 
Responsible consultant: Dr Morwenna Hodin, consultant paediatrician.