A&E Referral form for TIA - imperial.nhs.uk 2026

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The document is a referral form for TIA (Transient Ischemic Attack) intended for use in A&E settings. It includes sections for patient and GP details, assessment criteria using the FAST and ABCD2 tests, clinical features, risk factors, and a checklist of actions to take based on the patient's symptoms. The form outlines the referral pathway for TIA management, including urgent assessments and contact information for local stroke teams and clinics.

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Click ‘Get Form’ to open it in the editor.
Begin by entering patient details, including Name, DOB, Address, and NHS No. Ensure accuracy as this information is crucial for identification.
Next, fill in GP details. You can use a sticky label or stamp for convenience. Include the GP's Name and Practice.
Complete the clinical features section by marking 'Yes' or 'No' for each symptom listed under the FAST Test and ABCD2 Test.
Provide a brief description of the event(s) experienced by the patient. This is mandatory for appointment scheduling.
Review risk factors and check any that apply. This helps in assessing the urgency of the referral.
Finally, ensure all sections are filled out correctly before submitting your form through our platform.

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