Skip links and keyboard navigation


Minimum referral criteria

Category 1
Seen within 30 days

  • New episode(s) of uninvestigated syncope / near syncope without concerning features
    • Concerning features:
      • Exertional onset
      • Chest pain
      • Persistent hypotension (systolic BP < 90 mmHg)
      • Severe persistent headache
      • Focal neurological deficits
      • Preceded by or associated with palpitations
      • Known ischaemic heart disease or reduced LV systolic function
      • Associated with SVT or paroxysmal atrial fibrillation
      • Pre-excited QRS (delta waves) on ECG
      • Suspected malfunction of pacemaker or ICD
      • Absence of prodrome
      • Associated injury
      • Occurs while supine or sitting

Category 2
Seen within 90 days

  • Recurrent syncope previously investigated with undetermined cause

Category 3
Seen within 365 days

  • No category 3 criteria

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)

Essential information for Syncope/pre-syncope referrals

  • Details of all treatments offered and efficacy
  • Relevant medical history
  • Description of syncopal/pre-syncopal events including the following:
    • timeline
    • precipitating factors
    • any warning pre-syncopal symptoms
    • complete LOC or partial
    • duration of LOC
    • nature of recovery
    • witnessed signs
    • seizures
    • pallor
    • incontinence
    • cyanosis
    • irregular or absent pulse during attack
    • associated injury
  • Lying / standing or sitting / standing BP
  • Family history of cardiac disease or sudden cardiac death
  • Presence of impaired LV function by any imaging modality (MRI, echo or MPS) if known
  • FBC, TSH, ELFTs, magnesium results
  • All available ECGs
  • Echocardiogram report

Additional information for Syncope/pre-syncope referrals

  • Holter monitor report (only useful if daily symptoms)
  • CXR report
  • History of drug use (including recreational drugs)

Information for your patient

Expected time frame for appointment notifications

  • Once the request is received, categorisation by the hospital will occur.
  • General practitioners and patients are notified of the assigned category between 14 days to 1 month after completed request is received.
  • Patients are usually notified of the upcoming appointment time and date approximately 4 weeks prior unless short notice appointments become available.

Appointment information

  • Patients will be given an appointment via phone, SMS, or letter.
  • The patient must contact the hospital to reschedule if they are not able to attend.
  • If the patient fails to respond to 2 appointment offers:
    • They will be discharged back to their general practitioner.
    • They can have a new request for assessment sent to the hospital if the need still exists.
  • The patient's first appointment may not always be with a specialist. Where appropriate, the request may be sent to a public allied health or nursing service for initial assessment and management. A specialist assessment may then be arranged or ruled out.

Ask your patient to:

  • take a list of current medications, and all relevant radiology films and reports to appointments.
  • advise of any change in circumstance (e.g., getting worse or becoming pregnant), as this may affect the request for assessment.
  • update their contact details (e.g., phone number and address) with the hospital.
Last updated: 24 January 2020

Send referral

Specialist Outpatient Department

Fax: 1300 017 155

CQ Fracture/urgent referrals
Fax: (07) 4920 7242

Named referrals

If you would like to send a named referral, please address it to a specialist listed below.


  • Dr Rajesh Garg
  • Dr Ramachandran Kannan
  • Dr Sam Sidharta

> view all CQ Health specialists

Service advice

Rockhampton – Nurse Unit Manager
Phone: (07) 4920 6440

Phone: (07) 4976 3169.