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Bowel Screening

Send a copy of the National Bowel Cancer Screening notification/report with the Endoscopy Clinical Referral Letter (including details on symptoms, relevant medical history and current medications) to the GE Nurse Coordinator, Queensland Bowel Cancer Screening Program, Rockhampton Hospital.

Your patients care will be coordinated by the GE Nurse Coordinator.

When using the Rockhampton Hospital Referral form (Endoscopy), please ensure referral is flagged clearly as a National Bowel Cancer Screening participant to avoid the patient being placed on the General Surgery Waiting List.

There are reporting requirements by the National Cancer Screening Register and therefore important to clearly flag these referrals. Further program information can be found on

Standard information for all referrals

Reason for request

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

Patient's demographic details

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Phone contact numbers – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and Torres Strait Islander Ask the patient their ethnicity

Referring practitioner details

  • Full name
  • Full address
  • Contact details – phone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Patient's usual general practitioner (if different from above)

Relevant clinical information about the condition

  • Inclusion of Clinical Prioritisation Criteria (CPC) where relevant
  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Investigations carried out and results as indicated in the relevant pathway
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Options already pursued
  • 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
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

Clinical modifiers

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and Torres Strait Islander

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, WorkCover, motor vehicle insurance)
Last updated: 24 January 2020

Send referral

Service advice


Phone: (07) 4920 5747
Fax: 1300 017 155

Urgent referrals
Phone: (07) 4920 6211

Dr Garry Dyke
Director of Surgery

Fiona Petersen
GE Nurse Coordinator