These forms should be used by GPs when making a referral via the Electronic Referral System.
| File | Action |
|---|---|
| ERS Referral Form - Living with Diabetes Educational Service.doc | Download |
| ERS Referral Form - Haematuria | Download |
| ERS Referral Form - Community Diagnostic Service - Phlebotomy Service | Download |
| ERS Referral Form - Breast | Download |
| ERS Referral Form - Children | Download |
| ERS Referral Form - Combined Acute Community Trust Antibiotic Service | Download |
| ERS Referral Form - Community Cardiology Tape / Echo | Download |
| ERS Referral Form - Couples Subfertility Referral and Criteria | Download |
| ERS Referral Form - CT Request Form | Download |
| ERS Referral Form - CTS / Ulna Neuropathy | Download |
| ERS Referral Form – eTIA | Download |
| ERS Referral Form – Humber Neurology Service Guidance | Download |
| ERS Referral Form – Humber Post COVID-19 Long Syndrome referral with MDT outcome | Download |
| ERS Referral Form – Humber Post COVID-19 Long Syndrome referral without MDT outcome | Download |
| ERS Referral Form – Malignancy of Unknown Origin (MUO) | Download |
| ERS Referral Form - Routine Skin | Download |
| ERS Referral Form - Orthotics | Download |
| ERS Referral Form – Patient Urgent Suspected information leaflet | Download |
| ERS Referral Form - PMB Ultrasound Request | Download |
| ERS Referral Form – RACPC (Rapid Access Chest Pain) | Download |
| ERS Referral Form – Radiology Plain Film Fluoroscopy Request | Download |
| ERS Referral Form – Radiology MRI Request | Download |
| ERS Referral Form - Radiology Rapid Diagnostic Service | Download |
| ERS Referral Form - Radiology Rapid Diagnostic Service - History Questions | Download |
| ERS Referral Form – Radiology Spinal MRI Request | Download |
| ERS Referral Form - Radiology Walk in Chest Xray | Download |
| ERS Referral Form - T4 Bariatric Surgery | Download |
| ERS Referral Form - Transient Ischemic Attack (TIA) | Download |
| ERS Referral Form - Ultrasound Request Form | Download |
| ERS Referral Form - Urology | Download |
| ERS referral Form – USC Brain | Download |
| ERS referral Form – USC Colorectal | Download |
| ERS Referral Form – USC Gynaecology | Download |
| ERS Referral Form – USC Head and Neck | Download |
| ERS Referral Form – USC Hepatobiliary | Download |
| ERS Referral Form – USC Lung | Download |
| ERS Referral Form – USC Skin Cancer | Download |
| ERS Referral Form – USC Upper GI | Download |
Page Created: 5th January 2018
Last Updated: 11th April 2025
Last Updated: 11th April 2025