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Principles of dermatological practice

How to write a referral to a dermatologist

Created 2008.

Learning objectives

  • Complete a referral form according to the requirements of the New Zealand Ministry of Health.
  • Write a dermatological case history
  • Describe dermatological examination findings


A patient presents with a skin complaint. You decide to refer the patient to a dermatologist for further management. In this exercise, you will complete a standardised referral form to the local hospital's skin clinic.

Referral form

The New Zealand Ministry of Health requires standard referral forms to have the following minimal information.

  • Patient details: full name (and any alias) and if appropriate the name of the parent or caregiver, address, telephone number (home and alternative), date of birth, ethnicity
  • GP details: name, address, telephone number of referred doctor
  • Patient hospital number (NHI)
  • Accident status and claim number (if ACC)
  • Reason for referral (in line with referral guidelines)
  • Presenting symptoms and duration
  • Past history, details of previous treatment, current, medications
  • Details of previous radiological and other investigations
  • Physical findings
  • Recent test results and relevant old ones (dated)
  • Associated medical conditions that may affect treatment
  • Relevant details of social circumstances
  • Associated drug allergies
  • GP diagnosis
  • GP assessment of urgency, loss of function, pain


Write a referral for a woman in her mid-20s that suffers from moderate psoriasis. She is severely depressed and takes various relevant medications.


Related information


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