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Tower Hamlets wound care referral form

Please complete all the required boxes. Details which are missing will result in the referral being rejected. WE NO LONGER ACCEPT HAND WRITTEN REFERRALS.

On full completion, please email to @xRo!{WdYDyr7eUBPkh$?_S'X]#[#^?Ssq`F9~__wX332'Wi/hBhM.

You must provide a comprehensive medical history to support assessment. It is sufficient to attach an EMIS summary.


 Yes
 No
 Yes
 No
 Bariatric
 Bedbound
 Fully Mobile
 Housebound
 Mobile with Aids
 Wheelchair User
 Yes
 No
 Yes
 No
 Yes
 No
 Surgical wound
 Leg ulceration
 New PU 2
 New PU 3
 New PU 4
 Yes
 No
 

Accelerate CIC wound referral criteria guide

Accelerate CIC delivers a community Lower Limb and Wound Care service within Tower Hamlets.

Service description 

The service operates Monday-Friday, 09.00-17.00 and aims to support any patient who meets the referral criteria. Below is a simple guide, outlining the four indications for referral that must be met:

Referrals accepted: 

✓ Patient has at least one of the following: 

✓ In order to ensure an Accelerate joint visit, housebound patients must be referred to the community nursing team via Single Point of Access for first line assessment.

Referrals not accepted:

x Routine Doppler

x Varicose veins

x House bound pressure ulcers (refer to Single Point of Access)

x Chronic swelling/lymphoedema. Refer on lymphoedema form.