Referring to CHAIN

Information for Clinicians

If you are a clinician looking to refer a patient with hip osteoarthritis to the CHAIN programme, the following two forms need to be completed and sent to:
Professor Robert Middleton, Orthopaedics Outpatient Department, The Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW.
A member of Professor Middleton’s team will then check the patient’s eligibility for inclusion onto the programme.

Form 1 Patient Referral Form: This form needs to be signed by your patient after they have had the CHAIN programme explained to them. Every patient needs to give their consent for their details to be shared between the hospital (Royal Bournemouth), the Littledown Centre (BH Live), Bournemouth University and the data management company (Actipath), who all help to deliver CHAIN.

Form 1 Patient Referral Form

Form 2 Clinician Referral Form: This form is for you (the clinician) to complete, and contains the eligibility criteria for the CHAIN programme. If any of the exclusion criteria are ticked, your patient is unfortunately not suitable to take part in the programme. We also ask that you fill in the medical history section for each patient.

Form 2 Clinician Referral Form

CHAIN Patient Information Leaflet: Please download and print this patient information leaflet to give to your patient when referring to CHAIN so that they have some more information about the programme. We can arrange for you to have some hard copies of this leaflet delivered to your surgery or hospital. Please email to request these.

CHAIN patient information leaflet PDF

If you have any questions about the CHAIN referral process, please email or phone 01202 961651.