Form to fill in for Urine infections

Cystitis or Urine infections and their management (Information for patients)

We have changed the way we manage urine infections at the practice. If you think you have a urine infection you will be asked to fill in the form below and a clinician will call you back on the same day.

Urine dips are no longer carried out unless there is a clinical need as they are unreliable as a means of testing whether or not you have a urine infection.

PLEASE DO NOT HAND IN A URINE SAMPLE UNLESS YOU GET ASKED TO DO SO.

  • We do not dip urines at the practice anymore as urine dips are unreliable for testing for infection.

Urine infection form

This form needs to be filled in by all patients who think they may have a urine infection WITHOUT EXCEPTIONS. If the patient cannot fill it in then a family member, relative or carer can fill this form in for them. We no longer accept urine samples at the practice without this form being filled in either online or on a papercopy that you can pick up from the practice. You will be texted or called with advice by a nurse/dr on the same day that you fill in the form.

Name
Date of Birth
How long have you had symptoms for?
Please note that the advice for symptoms that are not severe and have occurred for less than 48 hours is to drink plenty and take paracetamol for the discomfort as needed. We do not normally give antibiotics unless symptoms are severe or have occured for more than 48 hours.
Do you (or the patient if you are filling in this form) have any severe symptoms
If none of the above, what symptoms do you have?
The result may take 2-5 days to come back. If your symptoms get worse instead of better you can call us back to be started on antibiotics.
Are you or could you be pregnant?
Do you have more than 3 urine infections a year, or ever been told that your infections are resistent to some antibiotics
Are you on steroids daily or any other medication or treatment which make you more likely to get severe infections?
Patients with chemotherapy, on methotrexate etc are more likely to have severe infection
Have you ever been admitted to hospital for treatment of a urine infection?
Have you got any allergies or ever had any problems with antibiotics?
You will be asked about these by the nurse if you have said yes.