Worcestershire School Nursing Service referral

Accessibility

Text Size:
Contrast:

Translate

Urgent help

Search the Herefordshire and Worcestershire Health and Care NHS Trust website

Please read the referral criteria below carefully before submitting the form:

We accept electronic referrals from Schools, Parents, GPs and other professionals for school aged children. If you need a word version, please email: whcnhs.shnaccessandresponse@nhs.net
We can accept telephone contact from parents for initial advice or for further referral information contact the service on 01905 520032. We also have a confidential texting service for parents via our Chat Health Parent Line: 07312 263547.
Young People can self-refer or chat with a school nurse via ChatHealth | Children, Young People and Families.
All referrals will be processed by our team, and responses will be sent via email. Please ensure you add your contact email address to the referral form.
You should expect to have a response to your referral within 14 days.

Further guidance:

If children/young people are already under the care of specialist health services and you need further information, this should be requested from the specialist service.
If you have any safeguarding concerns, please do not refer to this service. Follow your organisation’s safeguarding policy and/or make a direct referral to Worcestershire’s Family Front Door.
Please ensure that you have gained and documented consent from young person 13+ before submitting a referral.
Please only add one child per referral form (Siblings require separate referral forms to be submitted).

Referral exclusion criteria

Unfortunately we are unable to support with the below concerns:

Non-health related school absence referrals
Monitoring height and weight for other professionals who are already planning care.
If a child or young person has already been referred to or is under the care of a specialist bereavement service.
School-based behaviour concerns. These should be addressed by the school following own procedures.
Mental health concerns: If a referral to CAMHS or Community Paediatrics is needed, this should be completed by the professional who first identifies a concern, for example the child's school or GP. If there are immediate mental health concerns, please visit: Urgent help and support in an emergency | Children, Young People and Families.

School Health Nursing Referral

Note: Questions marked by * are mandatory

*This is a mandatory field. Referrer's Name

*This is a mandatory field. Referrer's Email Address:

*This is a mandatory field. Referrer's Phone Number:

*This is a mandatory field. Date of referral:

*This is a mandatory field. Relationship to child/young person:

*This is a mandatory field. Child/ Young Person's Name

*This is a mandatory field. Child/ Young Person's Date of Birth:

*This is a mandatory field. Child/ Young Person's Gender:

Child/ Young Person's NHS Number (if known):

*This is a mandatory field. Name of School:

Form/Year Group:

*This is a mandatory field. Ethnicity:

Language spoken if not English or other Communication Needs:

Interpreters needed?

Yes
No

*This is a mandatory field. Parent/ Carer's Name:

*This is a mandatory field. Relationship to child/young person:

*This is a mandatory field. Parent/Carer's Contact Number:

*This is a mandatory field. Parent/ Carer's Address (including postcode):

GP/ Surgery Name:

GP/ Surgery Address:

	Supporting resilience and wellbeing (e.g., bullying issues, domestic abuse concerns, managing tasks in daily life- washing, dressing, hygiene, general advice for toileting issues, routines)	Improving health behaviours and reducing risk taking (e.g., social media concerns, friendship groups, alcohol or drug misuse, smoking, sexual health, relationships, behaviour issues, puberty advice and support, Parenting groups)	Supporting healthy lifestyles (e.g., diet, sleep, poor diet and physical inactivity, Oral health)	Promoting self-care and improving health literacy (concerns around bullying, puberty, sexual health, gender identity, sexual orientation, Parenting strategies and support, information on support groups, support available in community)
*This is a mandatory field. What are the specific health issues that the School Nurse may be able to address? Please select the main reason from the following list
Please select any other additional health issues that the School Nurse may be able to address from the list

Please elaborate on the concerns raised above What are the specific health issues that the School Health Nurse may be able to address? Please include any relevant information that you feel may be beneficial. Does the child have any medical conditions or are they under the care of any other professionals? Any current medication (if known)?

What strategies/services have already been implemented, and when, to support the child/young person in meeting their health needs? Can you identify if there has been any involvement from other partners/agencies such as Early Help, Parenting Support or Family Support?

Does this child/young person have an Early Help Assessment in place?

Yes
No

*This is a mandatory field. Has verbal consent been obtained from a parent/carer for children under the age of 13 or from the young person if over the age of 13?

Yes
No
N/A

*This is a mandatory field. Name of person giving consent:

*This is a mandatory field. Relationship to the child/young person

*This is a mandatory field. Contact Number:

*This is a mandatory field. Email Address:

If consent is from a young person - how you would like to be contacted?

Letter
Telephone
SMS/Text
Video Call (Webex or Teams)

Young person's contact number

Young person's email address (could be a school email address)

Social-Worker Details (if applicable)

Child Protection Plan

Child in Need

*This is a mandatory field. Referrer’s signature

Worcestershire School Nursing Service referral

Search the Herefordshire and Worcestershire Health and Care NHS Trust website

Referral exclusion criteria

Our services submenu

Head Office

Our Partners