Primary Care Referrals

Primary care referrals are made using the paper forms available on the links below. These should be used by hospital doctors ONLY if the electronic referral system fails.


Referral forms

Please make sure your patient meets the eligibility criteria before completing the form – the full criteria are given in both the online and print versions of the forms. Referrals for conditions other than lower limb cellulitis must first be discussed with an infection specialist: contact either the duty microbiologist or ID consultant via HEFT switchboard (0121 424 2000).


Pre-printed antibiotic prescriptions

All patients must also have a completed pre-printed prescription for the IV therapy at home service. Access to the prescriptions has been restricted. Please use the links provided below.

  • Pre-printed Prescriptions are available for the commonly used antibiotics.
  • The forms cannot be altered. If an alternative antibiotic or dosing regime is required a blank prescription form must be used.
  • Completed pre-printed prescriptions should be sent to pharmacy – once the antibiotic is issued the script should be sent home with the patient. It acts as an administration chart for the community nurses.


Making the referral

Once complete all forms must be faxed to the relevant community service (phone numbers at the foot of the form) and receipt confirmed by a telephone call. The prescription should be given to the patient to take home.

For GP users only – Please login with your heartsol login,  for help with your login information contact the IT helpdesk on 4241130