№ files_lp_4_process_2_67179
Clinical referral assessment form used within the NHS commissioning framework to document patient information, clinical grading, symptoms, and eligibility criteria for specialist evaluation and possible surgical treatment of varicose veins.
Document Type: Medical referral approval form
Subject: Varicose vein surgery referral assessment
Healthcare System: National Health Service (NHS)
Clinical Area: Vascular surgery
Purpose: Assessment and approval of patient referral for consideration of varicose vein surgery
Patient Information Fields: Patient name, date of birth, address, contact number, NHS number, hospital number
Referral Information: Date of referral, referring GP, GP practice
Clinical Assessment Elements: Varicose vein grading, symptoms, clinical signs, co-morbidities, examination and medical history
Referral Criteria: Clinical grading system from 0 to V with associated symptoms and signs
Policy Framework: Commissioning policy of Redditch and Bromsgrove Clinical Commissioning Group
Related Procedure: Individual Funding Request process for exceptional clinical circumstances
Target Users: Referring clinicians and general practitioners
Medical Conditions Mentioned: Varicose veins, thrombophlebitis, venous hypertension, lipodermatosclerosis, varicose eczema, venous leg ulceration, deep vein thrombosis
Associated Treatments: Compression stockings, anti-inflammatory drugs, antibiotics, anticoagulation therapy
Price: 8 / 10 USD
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