Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • gastrointestinal bleeding
  • acute liver failure
  • sepsis in a patient with cirrhosis
  • severe encephalopathy in a patient with liver disease

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Women's and Children's Health Network

Category 1 - appointment clinically indicated within 30 days

Patients who are hepatitis B surface antigen (HBsAg) positive with:

  • evidence of decompensated liver disease, including:
    • jaundice and/or
    • ascites and/or
    • encephalopathy
  • untreated with alanine transaminase (ALT) greater than 100 units per litre
  • pregnant women with hepatitis B virus deoxyribonucleic acid (DNA) (“viral load”) greater than 200,000 IU/mL (based on Gastroenterological Society of Australia - Hepatitis B Consensus Statement)
  • pregnant women with abnormal ALT
  • people about to commence chemotherapy, immunosuppressants or treatment for tuberculosis

Category 2 — appointment clinically indicated within 90 days

  • patients who are HBsAg positive without any features of decompensated liver disease

Category 3 — appointment clinically indicated within 365 days

  • nil

For information on referral forms and how to import them, please view general referral information.

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • identifies as Aboriginal and/or Torres Strait Islander
  • for adult patients, relevant social history, including identifying if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
  • for paediatric patients, identify within your referral if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf
  • interpreter requirements


  • past medical/surgical history
  • family history of liver disease or diabetes
  • onset, duration, and progression of symptoms
  • current/previous medications and dosages, including supplements
  • use/ frequency of alcohol, tobacco, and other drugs
  • ​allergies and sensitivities
  • management history including treatments trialled/implemented prior to referral, and current regularity of hepatitis B monitoring.
  • history of incarceration, injecting, body art, or blood transfusions


  • abdominal examination results
  • features of hepatic failure, e.g. jaundice, ascites and/or encephalopathy
  • height/weight/body mass index (BMI)


  • complete blood examination (CBE)
  • liver function test (LFT)
  • urea, electrolyte, and creatinine (UEC)
  • international normalised ratio (INR)
  • hepatitis B virus (HBV) serology:
    • hepatitis B surface antigen
    • hepatitis B surface antibody
    • hepatitis B core antibody
    • hepatitis B e antigen (HBeAg)
    • hepatitis B e antibody (HBeAb)
    • hepatitis Delta antibody
  • hepatitis C serology (HCV): hepatitis C antibody with a request for pathology to reflexively test for HCV RNA if positive antibody result
  • alpha fetoprotein (AFP)
  • HBV deoxyribonucleic acid (DNA) (“viral load”)
  • human immunodeficiency virus (HIV) antigen/antibody

Additional information to assist triage categorisation

Upper abdominal ultrasound ± Liver elastography reports where available

Clinical management advice

Please note that hepatitis B referrals can be managed by the following specialist services:

  • hepatology
  • infectious diseases.

Category 3 referrals are accepted at the discretion of the triaging clinician. If you are concerned that your patient requires specialist review, but may not fit the criteria provided, you are encouraged to contact the specialist team to discuss your concerns.

Clinical resources

Consumer resources