Information for health professionals
Forms
The following forms are completed by smeartakers when taking Programme smears.
To assist with the completion of forms and data quality, a number of providers of General Practice management software products have developed electronic versions of the CervicalCheck cervical cytology and colposcopy referral forms.
Users of Health One, Socrates and Helix Health software products can access CervicalCheck cytology and colposcopy referral forms in electronic format. Smeartakers are advised to contact their software provider to arrange access to electronic CervicalCheck forms.
Completing the forms electronically will assist the quality of the cervical screening process. CervicalCheck smeartakers are encouraged to ensure a complete and legible form is submitted with each smear test to ensure quality and accuracy. A woman's signature indicating informed consent is required on every form.
Please click on the links below to download Programme referral forms.
This form should be completed in its entirety and sent with a sample from the smeartaker to the designated cytology laboratory for the National Cervical Screening Programme. Incomplete forms will be returned and ineligible samples / vials will be returned to the smeartaker.
This form should be sent to the designated colposcopy clinic for primary care referrals to ensure that an appointment is scheduled.
This form is used at colposcopy clinics for the diagnostic service of the Programme.
Adobe Acrobat Reader is required to view PDF files. This is a free programme available from the Adobe web site.
