SOP on Doctor Referral

Standard Operating Procedure: Effective Date: 13 March 2017

SOP number 26: How to Refer to Doctor on Abnormal GALAU (v 2.0)

When to Perform:
1. Every day from the outlet open until shift one end
2. Every day after ABNORMAL GALAU result found during the check

Preparation Material:
1. Abnormal GALAU referral form
2. GALAU and Blood Pressure book
3. Pen

How to Perform:
1. Take the Abnormal GALAU referral form and place it in GALAU room in the morning when shift
one start.
2. Every day after the shift one end go to GALAU and Blood Pressure book to find the ABNORMAL
GALAU and ABNORMAL BLOOD PRESSURE result.
3. Definition of ABNORMAL GALAU and BLOOD PRESSURE:
a. Blood Pressure: >140/90 mmHg,
b. Fasting blood glucose > 126 mg/dL, Random blood glucose > 200 mg/dL,
c. Cholesterol > 200 mg/dL,
d. Uric Acid: woman > 6 mg/dL and man > 7 mg/dL
4. Write down the number, patient’s name, address and phone number in the column 1 and 2 of
Abnormal GALAU referral form.
5. Write down the date of birth and membership number of patient in the column 3 of Abnormal
GALAU referral form.
6. Choose and write down the VALUE of ABNORMAL GALAU and BLOOD PRESSURE according
to patient’s condition in the column 4 to 7. Please refer to the normal range stated above the table to
help you determine ABNORMAL Condition.
7. Make a follow up phone call to patient who has at least one abnormal GALAU and Blood Pressure
Result to make an appointment based on time in the column 8.
8. If the patient agree to come to see the doctor then tick column 9 based on the agreed appointment
time (column 8).
9. If the patient disagrees to come to see the doctor then tick column 10 and write down the reason.
10. Sign and put your initial in column 11.
11. If patient disagrees to visit doctor then let doctor know about it so the second phone call follow up
will be made by the doctor.
12. After the second phone call follow up, doctor will fill column 12 and 13 depends on patient’s
decision. Column 12 will be filled based on patient’s agreement to come at the appointment time on
column 8.
The doctor should make a second phone call if there are some circumstances :
a. The Blood pressure > 160/100 mmHg
b. Fasting blood glucose > 200 mmHg, Random blood glucose > 330 mmHg
c. Cholesterol > 240mmHg ( Age : woman >45 years old, man > 50 years old, except smoking)
d. Uric Acid : woman and man >10 mg/dL
 e. If the number of patient ≥ 6 patient, the pharmacist/aa will take the responsible to do follow
up.
13. If patient still disagree then tick the column 14 and will do another follow up the next day.
14. Write down patient who want to see the doctor outside the practice time in the last row below
(outside GP schedule time)
 Abnormal GALAU Referral Form

Name of Outlet/ PM :
Date/ Shift :

Normal Range: Blood Pressure: < 140/90 mmHg Blood Glucose: Fasting 90-130 mg/dL; Random Glucose < 200 mg/dL Cholesterol: < 200 mg/dL Uric Acid: Woman < 6 mg/dL; Man < 7 mg/dL
Result of phone call follow up by Result of phone call follow up by
Abnormal GALAU (write down the value of abnormal result)
Patient’s Name/ Date of Birth & Pharmacist Doctor
Sign &
No Address/ Phone Membership Time Agree to come (tick Disagree to Agree to come
Blood Pressure Cholesterol Blood Glucose Uric Acid Initial Disagree to come
(1) Number Number (8) the box based on come (with (tick the box)/
(mmHg) (mg/dL) (mg/dL) (mg/dL) (11) (with reason)
(2) (3) time availability) reason) Time of coming
(4) (5) (6) (7) (13)
(9) (10) (12)

17.00-17.14

17.15-17.29

17.30-17.44

17.45-17.59

18.00-18.14

18.15-18.29

18.30-18.44

18.45-18.59

19.00-19.14

19.15-19.29

19.30-19.44

19.45-19.59

20.00-20.14

20.15-20.29

20.30-20.44

20.45-21.00

Pharmacy Manager,
This Form will be SUBMITTED every day at 5pm to the doctor in the outlet/ replacement doctor work in the outlet that day

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