East and North Hertfordshire
NHS Trust
Patient Referral Portal
Build:
20250813.1
New Referral
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Your details:
Title
Dr.
Mrs.
Mr.
Miss
Job Title
First Name
Last Name
Email Address
Mobile Phone Number
Location
Lister Hospital
Other
Luton and Dunstable Hospital
Bedford Hospital
Princess Alexandra Hospital Harlow
Watford General Hospital
Other Location
Reason for not referring to local renal centre
Patient details:
First Name
Last Name
NHS Number
Date of birth
Gender
Female
Unknown
Male
Ward/patient location
Best contact number (Not the hospital switchboard)
Patient known to renal centre
No
Unknown
Yes
Modality
Other
Unknown
Transplant
HD
PD
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