Digital Health Passport
Demo Base Hospital Homagama
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Referrals
Patients
Appointments
BH Homagama
· Referring clinician
SF
Dr. Sanduni Fernando
General Outpatient
Referrals
/
New e-Referral
New e-Referral
Ref
Draft · not yet issued
Referring doctor
Dr. Sanduni Fernando
SLMC SLMC-DEMO-91001
Referring facility
Demo Base Hospital Homagama
Department
General Outpatient
1.
Patient Identification & Demographics
Search by NIC or PHN
*
(required)
Look up patient
2.
Referral Details & Clinical Information
Referral type
*
(required)
Choose a type
Referral priority / urgency
*
(required)
Choose a priority
Reason for referral
*
(required)
Clinical summary / relevant clinical information
Vitals today
Blood pressure
mmHg, e.g. 120/80
Pulse rate
bpm
SpO2
%
Temperature
°C
Medicines to note
Known allergies
Special care needs
Tests already done
3.
Referral Destination & Appointment
Specialty / service
*
(required)
Choose a service
Eligible destination facility
*
(required)
Choose a service first
Clinic
*
(required)
Choose a hospital first
Choose a service, hospital and clinic to see the open days and times.
4.
Additional Note to Receiving Clinic
Notes for the receiving clinic
Download PDF
Clear form
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Submit e-Referral