Plaquenil/hydroxychloroquine screening Referral Access Criteria
Plaquenil/hydroxychloroquine screening Referral Access Criteria
Referrers should use this page when referring patients to public adult outpatient services for Plaquenil/hydroxychloroquine screening. |
Emergency referral |
If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region. |
|
Clinical indications for outpatient referral |
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS). |
- Patient on Plaquenil/Hydroxychloroquine
|
Mandatory information |
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reason).
This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
|
History |
- Details of previous treatment and outcome
- Plaquenil dose and duration mg/kg of patient
|
Examination |
- Best corrected visual acuity (BCVA) - vision with most recent distance spectacles
|
Investigations |
- Renal function and liver function
|
Highly desirable |
History |
|
Examination |
|
Investigations |
- Most recent optometrist or private ophthalmologist report:
- Colour vision
- Optical coherence tomography (OCT)
|
Indicative clinical urgency category |
Category 1
Appointment within 30 days
|
- No defined category 1 criteria
|
Category 2
Appointment within 90 days
|
-
High risk for retinal toxicity:
- Duration > 5 years & dose of > 5 mg / kg
- Or renal impairment
- Or liver impairment
|
Category 3
Appointment within 365 days
|
|
Feedback
If you would like to submit feedback on the contents of the Referral Access Criteria, please complete this form.