Nhs Reference Request Form Template UK

The NHS Reference Request Form Template UK is offered in multiple formats, including PDF, Word, and Google Docs, complete with editable and printable versions for your convenience.

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Sample

Nhs Reference Request Form Template UK

Editable – Printable

PDF – 1 PDF – 2

NHS Reference Request Form Template UK

1. Requesting Party Information



2. Patient Information



3. Reference Details

4. Clinical History

5. Consent to Share Information

6. Reason for Request

7. Additional Information

8. Data Protection and Confidentiality

9. Signatures and Agreement


PDF

WORD

Examples

NHS Reference Request Form Template UK (1)
To:
[Name of the NHS Trust]
[NHS Trust ID]
[Trust’s Address]
[Trust’s Phone]
[Trust’s Email]
From:
[Name of the Referrer]
[Referrer’s ID or Title]
[Referrer’s Address]
[Referrer’s Phone]
[Referrer’s Email]
Subject:
Request for Reference for [Name of the Candidate] – [Position/Role Applying For]
Introduction:
This request seeks a professional reference for [Name of the Candidate], who has applied for the position of [Position] within [Department/Unit]. The reference is to assist in evaluating the candidate’s suitability for the role, and is an integral part of the recruitment process.
Clause 1: Candidate Details
Full Name: [Name of the Candidate]
Date of Birth: [Candidate’s DOB]
Current Position: [Candidate’s Current Position]
Duration of Employment: [Duration at Previous Role]
Clause 2: Reference Requirements
We require references to address the following areas: [List specific areas, e.g., clinical skills, teamwork, communication skills, professionalism].
Clause 3: Information Confidentiality
All information provided in this reference will be treated confidentially and in accordance with data protection regulations.
Clause 4: Response Timeframe
We kindly ask for the reference to be completed and returned by [Response Deadline, e.g., within 14 days], to facilitate the application process.
Clause 5: Contact Information
If further information is required, please do not hesitate to reach out to me at [Referrer’s Phone or Email].
Thank you for your attention to this matter.
Sincerely,
[Signature of the Referrer]
[Name of the Referrer]
[Position of the Referrer]
[Organization of the Referrer]
NHS Reference Request Form Template UK (2)
To:
[Name of the NHS Trust]
[NHS Trust ID]
[Trust’s Address]
[Trust’s Phone]
[Trust’s Email]
From:
[Name of the Referrer]
[Referrer’s ID or Title]
[Referrer’s Address]
[Referrer’s Phone]
[Referrer’s Email]
Subject:
Request for Reference concerning [Name of the Candidate] – Application for [Position/Role Applying For]
Introduction:
This reference request is intended for [Name of the Candidate], who has applied for a role within our [Department/Unit]. Your insights will help us determine their fit for the position.
Clause 1: Candidate’s Previous Experience
Position Held: [Position of the Candidate]
Dates of Employment: [Start Date – End Date]
Key Responsibilities: [List key duties or responsibilities].
Clause 2: Assessment Areas
Please address the following in your reference: [List areas such as knowledge, skills, interpersonal abilities, and professional behavior].
Clause 3: Consent for Reference
The candidate has consented to this reference request and is aware that the information will be used for recruitment purposes.
Clause 4: Deadline for Submission
We ask that you submit your reference by [Submission Deadline, e.g., within 10 days] to ensure a timely application review.
Clause 5: Additional Information
Should you require any additional details, please feel free to contact me directly at [Referrer’s Phone or Email].
We appreciate your assistance.
Sincerely,
[Signature of the Referrer]
[Name of the Referrer]
[Position of the Referrer]
[Organization of the Referrer]

Printable

PDF – 1 PDF – 2

Nhs Reference Request Form Template UK