Untested and UNAFFECTED blood relative of a person with an identified gene mutation/chromosomal anomaly (predictive/presymptomatic testing) (A/P-UN)

Adult and Paediatric Conditions in UNAFFECTED Patients

Emergency referrals

If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • No referrals to emergency relating to clinical genetics

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • The patient has a family history (blood relatives) of a genetic condition AND the patient or their partner is pregnant and an opinion/genetic testing will guide investigations, management, and outcome in pregnancy

Category 2

Appointment within 90 days is desirable

Category 3

Appointment within 365 days is desirable

  • The patient has a family history (blood relatives) of a genetic diagnosis, where a specific gene mutation/chromosomal anomaly HAS been identified on a genetic test

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

  • If there are any queries regarding the appropriateness of a referral please contact GHQ.
  • In order to offer predictive/presymptomatic testing, the patient needs to be able to provide sufficient information for GHQ to obtain details of the familial gene mutation/chromosome anomaly and where possible, control DNA for testing. This information may include one or more of the following: copies of genetic test reports, family letters, names and DOB of family members and details of the genetic services where genetic testing has been done. This information should not be included with the referral but will subsequently be requested by GHQ.
  • Predictive/presymptomatic genetic testing is offered to children and adolescents ONLY if the results of genetic testing will change management (i.e. for conditions where surveillance or risk reducing medical or surgery management are recommended in childhood).
  • When a child has been referred for predictive/presymptomatic testing for a gene mutation associated with adult onset genetic disease risk, the referring doctor and parents will be provided information about appropriate age of re-referral.
  • Predictive/presymptomatic testing will not be offered for the following:
    • variant of uncertain significance (unclassified or class 3 variant)
    • variant in a gene of limited or unknown clinical utility
    • variant/s that have not been identified/confirmed using an accredited clinical laboratory (e.g. research genetic testing)
  • GHQ may provide families with partially completed referral proformas to facilitate referral. These referrals need to be completed IN FULL by the referring doctor.
  • Predictive/presymptomatic genetic testing should only be offered by a geneticist or genetic counsellor following genetic counselling and written informed consent (please see HGSA guideline on Pre-symptomatic and predictive testing for children and young adults).

Referral requirements

A referral may be rejected without the following information.

  • Name of genetic condition in the family and the name of the gene in which a mutation has been identified or details of the chromosomal anomaly identified in family.

Additional useful information (useful for processing the referral)

  • Known details of relevant family history (first and second-degree blood relatives) including:
    • clinical diagnosis/features and age at diagnosis
    • relation to patient including whether maternal or paternal
  • If the family is known to GHQ, the GHQ reference number (GF)
  • If the family are known to another genetic service, the name of the service and family reference number (if available)
  • Attach the “family information letter” if available
  • To preserve confidentiality, only include details or attach reports which identify another family member with the referral if consent has been obtained (see below)

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander
  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary
  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use
  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
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