High-risk Foot (Podiatry)
Adult

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Useful Management Information

No useful management information

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (aim for appointment within 2 working days)	Current foot ulcer with/without infection Current pressure injury with / without infection Suspected Acute Charcot Necrosis / dry gangrene (with or without ulceration)
Category 2 (aim for appointment within 1 month)	Previous foot ulceration or Previous lower limb amputation or Previous critical Peripheral Arterial Disease AND two or more of the following risk factors: Peripheral Arterial Disease Peripheral Neuropathy Significant Foot Deformity
Category 3 (appointment within 365 calendar days)	No category 3 criteria
If your patient does not meet the minimum referral criteria Assessment and management information may be found on a range of conditions at HealthPathways If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.) Please note that your referral may not be accepted or may be redirected to another service

Standard Referral Information

Reason for request

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can't order, or the patient can't afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
All conservative options that have been pursued unsuccessfully prior to referral
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

Willingness to have surgery (where surgery is a likely intervention)
Choice to be treated as a public or private patient
Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

Essential Referral Information

Details of all treatments offered and efficacy
Peripheral pulses, femoral/popliteal/foot
Is the ulcer neuropathic or ischaemic (or both) in origin?

Additional Referral Information

Is there an active infection? Consider deep wound swab/pathology for culture, ESR CRP FBC
Is there invasive infection with spreading cellulitis around the wound?
Is there bony infection? XR if required.
If suspected arterial disease –Doppler Ankle Brachial Pressure Index (ABPI), toe pressures, duplex scan etc
Appropriate medical history including claudication distance, rest pain, ischaemic changes and risk factors
Results of depression screening (PHQ-2)
- over the last 2 weeks, how often have you been bothered by any of the following problems?
  - little interest or pleasure in doing things?
  - feeling down, depressed, or hopeless?

Send Referrals To

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

Facilities

No facilities listed

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

High-risk Foot (Podiatry)Adult