Paediatric Nephrology - Referral Form Paediatric Nephrology - Referral Form 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in the 'Referrer Details' section. Enter the referral date and time, name of the referring hospital or GP, and details of the referring consultant.
3. Proceed to 'Patient Details'. Input the patient's given name, surname, date of birth, address, contact number, NHS number, and GP information.
4. In the 'Case Details' section, indicate if the patient has been previously seen at Evelina London and provide any relevant history regarding their nephrology care.
5. Complete the 'Main Diagnosis' field by stating your primary concern for referral. Fill in presenting symptoms and medical history as required.
6. Document current medications and clinical assessments including vital signs like blood pressure and recent weight/height measurements.
7. Input blood results under biochemistry and haematology sections. Ensure all relevant dates and times are noted for accuracy.
8. Finally, review all entries for completeness before submitting via email as instructed on the form.

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