Criteria for referral to public hospital specialist clinic services

• Missing or lost strings on an intra-uterine device
• Request for tubal ligation
• Where hormonal contraception is contraindicated
• Where contraception is unable to be managed in primary care due to a complex medical condition (e.g. immunosuppression, breast cancer, multiple sclerosis, physical disability).

Information to be included in the referral

Information that must be provided

• Past gynaecological history including menstrual health and details of previous experience with contraception
• Relevant family history.

Provide if available

• Most recent human papillomavirus (HPV) and liquid-based cytology (LBC) co-test result or cervical screening test results
• Sexually transmitted infections test results.

Additional comments

The Summary and referral information lists the information that should be included in a referral request.

Referrals should be made to suitable community-based services wherever possible (see 1800 My Options).

Where a public health service also operates a community health service or GP clinic, demand for reproductive health services should be met through these GP clinics.

Cervical screening test results may be provided from either self-collected or clinician collected samples.

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

Referral to a public hospital is not appropriate for

• Reversal of tubal ligation.

Note the statement on reversal of sterilisation in Victoria’s Elective Surgery Access Policy 2015.