Transformation Partners in Health and Care > Resources > Pan London Suspected Cancer Referral Forms – Word

Pan London Suspected Cancer Referral Forms – Word

An updated version of the Pan London Suspected Cancer Referral Forms are now available for EmisWeb, SystmOne (Integrated, Vision and DXS. Once the new forms have been installed please deactivate and remove all old versions.

In March 2021 the referral forms were updated and:

  • All forms are now compatible with both Read codes and SNOMED codes
  • Test results from past 6 months are now automatically populated (previous range was 3 months).
  • Indication of the patient’s risk of severe COVID-19 has been removed as a required field [this was added temporarily during the first wave of the COVID-19 pandemic]. Referrers can still record this if necessary, via the ‘additional clinical information’ box.
  • Telephone icons removed from all forms

Further changes have been made to the Haematology, Lower GI, Urology, Lung, Breast and Upper GI forms and can be viewed here.

Urgent care centres, out-of-hours primary care providers, hospital clinicians, dentists and optometrists are advised to use the MS Word version of the Pan London Suspected Cancer Referral Forms to refer patients with a suspected cancer.  When referring a patient, a copy should also be sent to the patient’s GP.

Where available, e-referral should be used to book or send the referral into secondary care. If this is is not available then the referral form should be sent via email account.

If you are using an older version of Internet Explorer, you may have problems downloading the forms.  Please try using another web browser i.e. Google Chrome. If the problem persists please email



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