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Plaquenil/hydroxychloroquine screening Referral Access Criteria

Plaquenil/hydroxychloroquine screening Referral Access Criteria

Referrers should use this page when referring patients to public adult outpatient services for Plaquenil/hydroxychloroquine screening.
Emergency referral
If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region.
  • Nil
Immediate referral
Orange exclamation mark in triangle: orange alertImmediately contact on-call registrar or service to arrange immediate ophthalmology assessment (seen within 7 days):
  • Nil
To contact the relevant service, see Clinician Assist WA: Acute Ophthalmology Assessment (external site)
Clinical indications for outpatient referral
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
  • Patient on Plaquenil/Hydroxychloroquine           
Mandatory information
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reason).

This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
History
  • Details of previous treatment and outcome
  • Plaquenil dose and duration mg/kg of patient             
Examination
  • Best corrected visual acuity (BCVA) - vision with most recent distance spectacles 
Investigations
  • Renal function and liver function
Highly desirable
History
  • Nil            
Examination
  • Nil
Investigations
  • Most recent optometrist or private ophthalmologist report:
    • Colour vision
    • Optical coherence tomography (OCT)
Indicative clinical urgency category

Category 1

Appointment within 30 days

  • No defined category 1 criteria

Category 2

Appointment within 90 days

  • High risk for retinal toxicity:
    • Duration > 5 years & dose of > 5 mg / kg
    • Or renal impairment
    • Or liver impairment           

Category 3

Appointment within 365 days

  • On Plaquenil
Exclusions
  • Nil
Useful information

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