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. Author manuscript; available in PMC: 2016 Mar 1.
Published in final edited form as: Int J Surg. 2015 Feb 4;15:74–78. doi: 10.1016/j.ijsu.2015.01.033

Table 1.

Suggested desired and essential items for surgical referral in low- and middle-income countries.

Desirable Essential
Date referred Patient's age
Referrer contact Working diagnosis
Patient contact Reason for referral
Gender Abbreviated history of present illness
Language needed Diagnostic tests to date
Medical history or treatment provided
Surgical history or treatment provided