Surgeon referral pathway

Pre-op & Post-op referral

Submit a structured referral for patients who may benefit from pre-operative optimisation or post-operative rehabilitation. The SOAR team will triage the patient and coordinate the right practitioner pathway.

Patient details

Patient name

Patient phone

Patient email

Date of birth

Surgical details

Referring surgeon

Referring practitioner email address

Practice / rooms

Referral type

Procedure

Planned surgery date

Hospital

Urgency

Referral focus

Medical optimisation Nutrition / weight optimisation Mobility / conditioning Pain optimisation Wound care referral Anxiety / emotional readiness Anaesthetic risk review

Clinical flags

Diabetes Smoking Anticoagulation Frailty concern Limited mobility Poor nutrition / weight concern Chronic pain Previous surgical complication

Billing & Medical Aid

Private / cash patient — I do not have medical aid cover for this visit

Medical aid scheme name

Plan type

Main member full name

Main member ID number

Dependant code

I hereby acknowledge that I am ultimately responsible for the full payment of services received at SOAR Health Centre, and agree to settle any amounts not fully covered or settled by my medical aid scheme.

Additional notes

ICD-10 codes / reason for referral

Clinical context / request

Preferred SOAR MDT member / pathway

Preferred patient contact

Referral submitted

The patient has been added to the SOAR dashboard for pre-op triage. The team can now contact the patient and link them to the patient assessment.