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referrers

(07) 5638 1259

Referrals

Patients may be referred to Coastal Respiratory & Sleep Specialists through Medical Objects (preferred), fax, email, phone, or the referral form below.

Download Referral Form (PDF)
Download Best Practice Template (RTF)
Download Medical Director Referral Template (RTF)

Complete Online Referral Form

Urgent referrals may be arranged by contacting our friendly reception staff on (07) 5638 1259.

Referral or Enquiry

Please submit using the referral form below. We endeavour to see all urgent referrals within 1 week.

Enquiries
For general enquiries, please contact our team by calling us on (07) 5638 1259, emailing info@coastalrss.com.au or filling out the General Enquiry form

RESPIRATORY AND SLEEP REFERRAL

Referrer Details

Doctor Name

Provider number

Date

Patient Details

Name

Date of birth

Address

Postcode

Phone

Gender

M F

Medicare DVA Work Cover Private Health

Reason for Referral

Respiratory Consult Sleep Consult Sleep Study PLUS Consult Occupational Consult Direct to Sleep Study (please refer to MBS criteria below)

Relevant Clinical Information

Next Available Doctor Preferred Doctor

Preferred Doctor (if selected above)

Lung Function Testing

Comprehensive lung function (spirometry, diffusing capacity, body plethysmography +/- bronchodilator) Spirometry & Diffusing Capacity Spirometry Pre & Post Bronchodilator

Sleep Study

Important: To qualify for a Medicare subsidised sleep study, your patient needs to score 3 or more on STOPBANG and 8 or more on ESS. If your patient doesn’t qualify, please refer them for a Sleep Study PLUS consult.

STOPBANG

Please tick if applicable: tick = 1

Does the patient snore loudly? Does the patient feel tired during the day time? Has anyone observed the patient to have stopped breathing during sleep? Is the patient being treated for high blood pressure? Is the patient’s BMI greater than 35? Is the patient’s age 50 or older? Is the patient’s neck circumference greater than 40cm? Is the patient’s gender male?

Total