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Referrals and useful information

Below you can find referral forms, information about clinical thresholds, DXS Point of Care and pathways/briefings that have been shared with practices along with other useful related information.

DXS Point of Care is your first point of call for referral forms and pathways.

Referral Form Library

This referral form library has been collated from those forms currently in use by practices.

The library contains forms that are compatible with EMIS Web and historic documents (pre-May 2015) for SystmOne.

Can't find what you're looking for?
Try looking at DXS Point of Care, which will direct you to the correct pathway and referral form.


Once you have located your form, save it to your PC. It will be either a .DOC (Word) or .EWDT (EMIS Web Document Template). Navigate to the ‘Templates’ section of EMIS Web and use the ‘Import’ button on the ribbon to select the downloaded file.

.EWDT files will already have the merge fields inserted by the ‘Clinical Systems Support Team’.

TPP SystmOne

From May 2015: SystmOne referral forms and ‘Advice Letter Listing’ (A.L.L.) letters are now being published directly into your clinical system; they will no-longer be added to this website. Each time the ‘Clinical Systems Support Team’ (CSST) are supplied with form updates, the published forms will be amended and then be available for use within minutes. This means that if you use the published documents you will not have to maintain these documents yourselves and updates will be seamlessly available. ‘Trust Contacts’ will be added for each referral so that surgeries can make effective use of the ‘Referral Wizard’.

The CSST will always create forms in best-practice format. This means referral forms to be sent via secure email will always be published with the data source type ‘Referral’ so they can be used correctly with the Referrals node. A.L.L. and ’e-Referral Service’ forms will be published with the data source type ‘None’ so they can be used within the ‘Communications & Letters’ node and then attached to eRS ‘Referral’ in the Referral node. Where surgeries choose to use non-standard ways of working (i.e. Creating eRS referral documents within the ‘Communications & Letters’ node) they will need to continue to maintain each document themselves and will not be able to make use of the forms published by the CSST.

Prior to May 2015: Forms for SystmOne were available either as .DOC (Word documents) or .XML (SystmOne Word Letter Templates). Right-click and save to your PC.
Within SystmOne navigate to: ‘Setup’ > ‘Referrals & Letters’ > ‘Word Letter Templates’.
For .DOC, use the ‘New Template’ button; for .XML, use the ‘Import Templates’ button.
Select the saved file from your PC.

.XML files will already have the merge fields inserted by the ‘Clinical Systems Support Team’.


If you have any queries please do not hesitate to contact us:

Clinical Systems Support Team



Important Notice - Use e-Referral Service

As from 1 October 2016, Ipswich Hospital will not accept written referrals for any specialty that is available on e-Referral (Choose and Book). Any written referrals received that could have been sent via e-Referral will be rejected and a letter sent to the referring GP.

Useful documents

Community Podiatry Direct Referral Letter

Medication and Falls Risk

Pulmonary Rehab Referral COPD Winter Pressures (Word doc format)

Monthly Headache Diary

Public Health commissioned services referral forms

Patient Information Leaflets
Why have I been referred to hospital?
Two week wait referral information leaflet for patients 

28 Day Faster Diagnosis Fact Sheet
Information for patients about The 28-Day Faster Diagnosis Standard

Dementia Together
Information for patients and carers

Public Health England
MERS-CoV Risk Assessment June 2015
MERS-CoV Algorithm for Primary Care
MERS-CoV Possible Cases Algorithm

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