Is patient diabetic? --- Is patient at high risk of diabetes? --- (BMI 30) ≥ HbA1c HbA1c > 69mmol/mol (if diabetic or high risk of diabetes) Threshold for referral Smoking Status --- (required for New Devon CCG optimising referrals LES) If smoker, has patient been advised that they should --- ideally be smoke free for 8 weeks prior to surgery? Body Mass Index (BMI) --- (required for New Devon CCG optimising referrals LES) Primary Reason for Referral: (an opening statement outlining the question the GP wishes to be answered). Referral letter: (Include any advice or management plans, or attach physio/ESP referral letter) Relevant Past Medical History: Current Medication: Allergies: (Medication or other adverse effects)
Is patient diabetic? --- Is patient at high risk of diabetes? (BMI ≥ 30) --- HbA1c (if diabetic or high risk of diabetes) HbA1c > 69mmol/mol Threshold for referral Smoking Status (required for New Devon CCG optimising referrals LES) --- If smoker, has patient been advised that they should ideally be smoke free for 8 weeks prior to surgery? --- Body Mass Index (BMI) (required for New Devon CCG optimising referrals LES) --- Primary Reason for Referral: (an opening statement outlining the question the GP wishes to be answered). Referral letter: (Include any advice or management plans, or attach physio/ESP referral letter) Relevant Past Medical History: Current Medication: Allergies: (Medication or other adverse effects)