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Polycystic ovarian syndrome (PCOS)

Minimum referral criteria

Category 1 - Seen within 30 days

  • Abnormal endometrium on ultrasound (i.e., irregular or focal lesion or thickened – over 12 mm).

Category 2 - Seen within 90 days

  • No category 2 criteria.

Category 3 - Seen within 365 days

  • Polycystic ovarian syndrome as per Rotterdam criteria:
    Two of the following three criteria are required:
    • Polycystic ovaries on ultrasound (either 25 or more follicles per ovary or increased ovarian size (> 10 cc))
    • Oligo or anovulation
    • Hyperandrogenism:
      • Clinical (hirsutism or, less commonly, male pattern alopecia)
      • Biochemical (raised FAI or free testosterone)

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

  • Pelvic ultrasound (including transvaginal (TVS))
  • Day 21 progesterone (D21P)
  • Sex hormone binding globulin (SHBG) results
  • Free testosterone
  • Fasting blood glucose results
  • Lipids, TSH results

If problems with subfertility

  • History of:
    • Previous pregnancies, sexually transmitted diseases (STDS) and pelvic inflammatory disease (PID), surgery, endometriosis
    • Other medical conditions
  • Include the following information about partner – age and health, reproductive history, testicular conditions
  • Weight or BMI
  • FBC group and antibodies, rubella IgG, varicella IgG, syphilis serology, hepatitis b hepatitis c human immunodeficiency virus serology results
  • Day 21 serum progesterone level (7 days before the next expected period)
  • FSH, LH (day 2 to 5), prolactin, thyroid-stimulating hormone (TSH) if cycle prolonged or irregular
  • Sexually transmitted infection (STI) screen result – endocervical swab or first catch urine for chlamydia with or without gonorrhoea nucleic acid amplification (NAA)
  • Partner semen analysis result
  • Pelvic ultrasound (TVS preferable on day 5 to 10)

Additional information

  • No additional information

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 David Hill, Department Director
  • Dr David Shaker
  • Dr Leigh Grant
  • Dr Lilantha Wedisinghe
  • Dr Theron Moodley
  • Dr Preeti Patil


  • Dr Surafel Alemu, Department Director
  • Dr Clive Green
  • Dr Amita Roy
  • Dr Anja Szabo


  • Dr David Hill, Department Director
  • Dr Leigh Grant


  • Dr David Hill, Department Director
  • Dr Leigh Grant

> view all CQ Health specialists

Service advice

Phone: (07) 4920 6440

Phone: (07) 4976 3169

Phone: (07) 4987 9750

Phone: (07) 4992 7000


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