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

  • Current cervical screening 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.

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.