All external referrals to PICU must have the data below submitted. This will be sent to the data manager and Consultants; please complete accurately and with detail where possible
If you do not have a decision / outcome at point of submitting this form, please submit the outcome ASAP with this form (essential!): www.GeorgesPICU.org.uk/decision
*This form is not an emergency referral process. It is for data capture. No immediate response should be expected.
Main Referral Data Form: