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Health and medical records · HM-215 · Tracker

Specialist Referral Tracker

Free printable referral tracker — who referred you, to whom, the date, the appointment when it comes and the wait in days. PDF, Excel and browser versions.

First page of the Specialist Referral Tracker printable — every referral with the date it was made and who made it
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2 pages. The A4 and US Letter files are laid out identically, so neither is shrunk to fit.

Print it and write on it

Fillable PDF type and save

Spreadsheet formulas included

The fillable versions have real form fields — open them in any PDF reader, type into them and save. Printing help.

Fill it in online

The same sheet, on screen. Totals and figures are worked out as you type, rows can be added or removed, and you can print it or download the completed version as a PDF. Everything stays in your browser — your entries are kept in this browser's own storage on this device, nothing is uploaded, and there is no account.

Who this is for

A tracker for referrals, from the day one is made to the day something comes of it. Each row holds who referred you and to whom, the date it went, the urgency you were told, the appointment date once you have it, the wait in days and what the outcome was — so a referral cannot quietly go missing.

Anyone waiting on a referral, patients under more than one department at once, people chasing an appointment that has never arrived, and relatives or carers doing the chasing on somebody else's behalf.

What this helps you track

  • Every referral with the date it was made and who made it
  • Which department, clinic or specialist it went to, and the reference if you have one
  • The urgency you were told, in the words you were given
  • The wait in days between the referral and the appointment
  • What came of it, and whether anything further was arranged

How to use it

  1. Fill in your details and your practice at the top so the sheet stands on its own when you hand it over.
  2. Start a row on the day you are told a referral is being made, not when a letter arrives.
  3. Write the urgency exactly as it was described to you, and nothing more — the sheet has no categories of its own.
  4. Add the appointment date when you get it; the days column counts the wait between the two dates.
  5. Record the outcome in a few words, and tick the column when the referral is closed off.
  6. Chase the rows that are still empty after a fortnight and note the date and the name of whoever you spoke to.

Formats

  • Printable PDF (A4 and US Letter)
  • Fillable PDF with form fields
  • Fill in online, saved in your browser
  • Excel / Google Sheets workbook

The printable is laid out inside a box that fits both A4 and US Letter, so the two files are identical and neither one is scaled. The fillable PDF has real form fields. The workbook uses plain formulas only — SUM, IF, COUNTIF and the like — so it opens in Excel, LibreOffice and Google Sheets without anything breaking, and every calculated cell is grey so you can see which figures it worked out.

How to print

Download the A4 or US Letter file to match the paper in your printer, open it in a PDF reader and print at 100% — not "fit to page", which shrinks the writing space. Both files leave a 14 mm margin, which clears the unprintable edge on home printers. To print the online version with your entries in it, use the Print this sheet button, which prints only the sheet and none of the page around it. More on printing.

Questions

Does the tracker say how long a wait should be?

No. It carries no target, no expected wait and no view about any figure on it. The days column subtracts one date from another, which is all it does.

What goes in the urgency column?

Whatever word you were given, copied across. Different services use different terms and they mean different things in different places, so the sheet supplies none and simply records yours.

Why record who referred me?

Because when a referral goes astray you have to go back to whoever made it, and months later nobody remembers which clinician that was. A name and a date settle it in one phone call.

What if a referral is declined or redirected?

Write that in the outcome column with the date and the reason you were given. A declined referral is one of the easiest things to lose track of, and the record of it matters at the next appointment.

Related resources

Also in the library

Printable sheets, workbooks and tools on the same subject.

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