Useful documents

This page includes useful documents for Local Haemoglobinopathy Teams including referral forms and MDT forms. These documents are intended for healthcare professional use.

If you are looking for a specific form here but cannot find it, please get in touch via the ‘Get Involved’ page or via direct email.

Patients may need to be referred to the HCC/SHT teams for MDT discussion or referral for regional services. These forms should be completed by the local haematology team.

South West HCC MDT referral proforma

This form is for LHT use to refer a regional patient to the HCC MDT.

Regional support worker referral

This form should be completed by LHT clinicians to refer a regional patient for support worker input.

Regional psychology referral

This form should be completed by LHT clinicians to refer a regional patient for psychology support.

Annual review proformas

These forms can be used when completing an annual review locally (if not a joint appointment with UHBW).

Sickle Cell Annual Review Template

Thalassaemia Annual Review Template

Regional annual review forms

This list of documents includes referral forms for regional annual review. If the patient has not been seen by the UHBW team before, please complete the ‘new patient referral’ form. If they have been seen previously, please complete the ‘follow up’ form.

Time to Analgesia – this should be completed once every 6 months, looking at adherence to NICE guidance on analgesia in sickle cell painful crisis
Time to Transfusion – this should be completed by LHT centres who provide transfusion programmes to patients with thalassaemia and RIA. This looks at the time taken to deliver a transfusion, from arrival on the unit to discharge.

The Excel sheets attached contain all of the information required for registration of audit and collection of data. Please contact us if you have any questions about performing audits at your LHT.