Emergency Referral Form
This form has been designed for Chiropractors by the Royal College of Chiropractors to be used for emergency referral of patients suspected of having a condition that requires immediate medical attention such as cauda equina syndrome, fracture, stroke, MI or other emergency condition. When completed in full, the form includes the essential information required to facilitate A&E triage.
Guidance for use
- In case of an emergency, instruct the patient to present the completed form to their nearest Accident and Emergency Department without delay (i.e. same day) or, if relevant, pass the completed form to ambulance staff.
- The form is for emergency referrals to A&E only. You should not use this form for urgent or routine referrals to a General Practitioner - a letter is more appropriate in these situations.
- Ensure you retain a copy of completed forms for your records.