BevApp in general practice

This part of the compendium links together three fields that are often treated separately: understanding of function (ICF) (1), clinical work in general practice, insurance medicine, use of imaging diagnostics, and referrals to specialist healthcare services (2,3). In practice, they meet in the same consultation: the patient with long-lasting MSK complaints, reduced work capacity, unclear findings, and a system that requires precise assessments of function, treatment, and prognosis.

The BevApp perspective shifts the focus from "what is wrong with the patient?" to "what can the patient actually do, under what conditions, and what can be changed?" (1,4). This is the core of the ICF, in the Norwegian function form, and in NAV's expectations for medical certificates (2,3).

Reference list

1. WHO. International Classification of Functioning, Disability and Health (ICF). Geneva: World Health Organization; 2001.
   Available from: https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health
2. The Norwegian Directorate for Health and Social Affairs. International Classification of Functioning, Disability and Health (ICF). Oslo: The Norwegian Directorate for Health and Social Affairs; 2003. 2nd edition 2006. ISBN: 82-7846-204-6.
   Available from: https://aktivesammen.no/irisfile/215819/icf-fullversjon-pdf-1pdf.pdf
3. The Norwegian Directorate of Health. Use of coding system – International Classification of Functioning, Disability and Health (ICF). Oslo: Norwegian Directorate of Health; 2018.
   Available from: https://www.helsedirektoratet.no/veiledere/registrering-av-iplos-data-i-kommunen/om-funksjonsvurdering-og-skarinndeling/bruk-av-kodeverk-internasjonal-klassifikasjon-av-funksjon-funksjonshemming-og-helse-icfBrage S, Fleten N, Knudsrød OG, Reiso H, Ryen A. Norwegian Functioning Questionnaire – a new instrument for sick leave and disability assessment. Tidsskr Nor Legeforen. 2004;124(20):2472–2474.

ICF (International Classification of Functioning, Disability and Health) is a framework that helps general practitioners describe function, not just diagnosis. It provides a common language for understanding how illness affects everyday life. Using ICF in practice gives a comprehensive assessment of the patient's situation, captures functional impairments that are not shown in diagnoses, supports interdisciplinary collaboration (NAV, physiotherapy, occupational therapy, specialist healthcare services), and improves documentation for sick leave, rehabilitation, and long-term complaints.

The doctor shall use the ICF model to document:

• What is wrong with the patient, the diagnosis (Health condition)
• Aspects related to the illness (Body functions)
• What is found during examination
• How the disease has been treated
• Whether all treatment options have been tried

The ICF model describes:

• health condition (disease or disorder)
• body functions and structures
• activities
• participation
• environmental factors
• personal factors
• Consequences of the disease (activity limitation, participation restriction)
• Environmental factors (physical, social, cultural)
• Personal factors (age, gender, education, social status, cognitive status, coping, life experience)

ICF (International Classification of Functioning, Disability and Health) is WHO's framework for describing function, disability, and health. It is explicitly designed to complement diagnostic classifications such as ICD and ICPC-2: where ICD and ICPC-2 state what kind of disease the patient has, ICF states how the patient functions in relation to everyday life, work and surroundings (1,3).

ICF distinguishes between:

• Body functions and structures – e.g., reduced mobility in the shoulder, decreased strength, pain, cognitive impairment.
• Activities – specific tasks: walk 500 meters, lift 10 kg, sit for 30 minutes, concentrate for 20 minutes.
• Participation – roles and areas of life: being at work, participating in family life, leisure activities, community life.
• Environmental factors – work environment, aids, transportation, support schemes, attitudes.
• Personal factors – age, education, coping style, previous experiences, motivation.

In social security and work capacity assessments, it is not enough to describe the diagnosis. NAV and other actors need to know: What can the patient do? Under what conditions? What hinders participation? What can be changed? ICF provides a common language for this, and is therefore recommended for use in functional assessments, both in municipal services and in work-oriented rehabilitation (3,4).

For MSK patients, this is particularly important: two people with the same diagnosis (e.g., lumbago) can have completely different functional ability, work capacity, and participation. ICF helps you describe this in a nuanced and systematic way (1,4).

Reference list

1. WHO. International Classification of Functioning, Disability and Health (ICF). Geneva: World Health Organization; 2001. Available from: https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health
2. The Norwegian Directorate of Health. Use of coding system – International Classification of Functioning, Disability and Health (ICF). Oslo: Norwegian Directorate of Health; 2018.
   Available from: https://www.helsedirektoratet.no/veiledere/registrering-av-iplos-data-i-kommunen/om-funksjonsvurdering-og-skarinndeling/bruk-av-kodeverk-internasjonal-klassifikasjon-av-funksjon-funksjonshemming-og-helse-icf
3. Great Medical Encyclopedia. International Classification of Functioning, Disability and Health – ICF. Oslo: Great Medical Encyclopedia; updated 2023.
   Available from: https://sml.snl.no/Internasjonal_klassifikasjon_av_funksjon,_funksjonshemming_og_helse_-_ICF
4. Brage S, Fleten N, Knudsrød OG, Reiso H, Ryen A. Norwegian Functioning Questionnaire – a new instrument for sick leave and disability assessment. Tidsskr Nor Legeforen. 2004;124(20):2472–2474.

NAV recommends that the general practitioner considers:

• Who says what about the medical condition: The patient's version, The general practitioner's version, The specialist's version.
• The patient's functional ability
• Has treatment been carried out?
• Objectivity in the description of the medical condition
• Timeliness, does the description of the medical condition reflect the current status? (1.3)

When you write a medical certificate to NAV, you do not primarily act as the patient's advocate, but as a medical expert. NAV therefore places great emphasis on:

• Source criticism: Is it clear what is the patient's own description, what are your findings, and what are your assessments?
• Function: Is the functional ability described concretely, not just the diagnosis?
• Treatment: Have relevant treatment options been tried, and is it justified if not?
• Objectivity: Is the statement balanced, or influenced by party positions?
• Timeliness: Is the assessment recent, or a reuse of old formulations?

NAV and several professional environments have pointed out that many medical certificates are too diagnosis-heavy and function-poor: there is much about MRI findings, little about what the patient can actually manage in daily life. ICF and the Norwegian Function Assessment are developed precisely to remedy this (2,3).

Reference list

1. NAV. Medical certificate for work incapacity (NAV 08-07.08). Oslo: The Norwegian Labour and Welfare Administration; 2024.
   Available from: https://www.nav.no/fyllut/nav080708
2. The Norwegian Directorate of Health. Medical certificate for incapacity for work – National e-health standard (HIS 80805:2008). Oslo: The Directorate of Health; 2008. Available from: https://www.helsedirektoratet.no/standarder/legeerklaering-ved-arbeidsuforhet

• Be clear about what the certificate is based on.
• How well do you know the patient?
• Distinguish between the patient's information and your professional assessments.

In social security medical assessments, it is crucial to distinguish between:

• Subjective report: the patient's own experience of pain, fatigue, function.
• Objective findings: clinical examination, tests, observations.
• Professional assessment: your interpretation of the relationship between illness, function, and work capacity (1-3).

A good statement makes this explicit: "The patient reports…", "On examination I find…", "In my assessment…". This increases credibility and makes it possible for NAV to understand where the uncertainty lies.

In practice, it is often the case that functional ability cannot be measured completely objectively. Then systematic tools (such as the Norwegian Function Assessment) and clinical observation become particularly important (1).

Reference list

1. Brage S, Fleten N, Knudsrød OG, Reiso H, Ryen A. Norwegian Function Assessment – a new instrument for sick leave and disability evaluation. Tidsskr Nor Legeforen. 2004;124(20):2472–2474.
2. NAV. Requirements for documentation in medical certificates. Oslo: Norwegian Labour and Welfare Administration; year not provided.
3. The Norwegian Medical Association. Social medicine – source criticism and objectivity. Oslo: The Norwegian Medical Association; year not provided.

• How does the health condition limit the patient's function?
• Function includes both bodily functions (movement, lifting, balance) and cognitive, social, and mental function.

Function is the bridge between diagnosis and work ability (1-3). For MSK patients, it is often not the diagnosis itself that determines if they can work, but:

• how long they can stand, sit, walk
• how much they can lift
• how often they need to rest
• how well they tolerate concentration and stress
• how pain affects sleep, mood, and social functioning

WHO and the Directorate of Health emphasize that functional assessment must be holistic: both body, activity, and participation should be described. The Norwegian function form is a concrete tool that operationalizes this in 40 questions divided into physical and mental functional areas (2,3).

Reference list

1. WHO. International Classification of Functioning, Disability and Health (ICF). Geneva: World Health Organization; 2001.
2. The Norwegian Directorate of Health. About functional assessment [online document]. Oslo: Directorate of Health; 2018. Last professional update: June 27, 2018. Available from: https://www.helsedirektoratet.no/veiledere/registrering-av-iplos-data-i-kommunen/om-funksjonsvurdering-og-skarinndeling/om-funksjonsvurdering
3. Brage S, Fleten N, Knudsrød OG, Reiso H, Ryen A. Norwegian Functioning Questionnaire – a new instrument for sick leave and disability assessment. Tidsskr Nor Legeforen. 2004;124(20):2472–2474.
4. Work & Inclusion. Functional Assessment – Industry Standard. Oslo: Work & Inclusion; 2018. Available from: https://www.arbeidoginkludering.no/contentassets/88638b25f8664fd38d1c0b1edeedcf29/bransjestandard-funksjon_revidert18.pdf

• What treatment has been completed?
• Is treatment remaining?
• Justify if recommended treatment has not been attempted.
• Describe contraindications, lack of availability, refusal, patient resistance.

NAV and specialist healthcare services expect that (1-3):

• common, evidence-based measures has been attempted before concluding permanent reduced work capacity
• it is documented why certain measures are not applicable (e.g., contraindications, lack of availability, the patient's justified resistance)

For MSK disorders this typically means:

• structured physiotherapy/training
• workplace assessment/adaptation
• cognitive approach for fear/avoidance
• pain management
• possibly interdisciplinary rehabilitation

When this has not been done, NAV will often request it. When it has been done, but without effect, it strengthens the assessment that the loss of function is real and persistent.

Reference list

1. The Norwegian Directorate of Health. Sick Leave Guide – National Guide. Oslo: The Norwegian Directorate of Health; 2024.
   Available from: https://www.helsedirektoratet.no/veiledere/sykmelderveileder
2. The Health Library. Sick Leave Guide – Professional guide for sick leave issuers. Oslo: The Norwegian Electronic Health Library; 2024. Last professionally updated: June 26, 2024. Available from: https://www.helsebiblioteket.no/innhold/nasjonale-veiledere/sykemelderveileder
3. NAV – The Norwegian Labour and Welfare Administration. Appendix 1 to the National Insurance Act Chapter 8: Guide for filling out and using the sick leave form (V1-08-00). Oslo: NAV; 2002.
   Last changed: June 1, 2010.
   Available from: https://lovdata.no/nav/rundskriv/v1-08-00
4. The Norwegian Medical Association. Social Insurance Medicine – Treatment and Function. Oslo: The Norwegian Medical Association; year not specified.

Chapter 7 – Objectivity

• You should be careful, precise, and objective.
• You assess health condition, not performance.
• Statements like "should receive disability pension" weaken the declaration.

Objectivity does not mean that you should be cold or distant, but that you (1-3):

• distinguish between facts and assessment
• do not promise the patient specific benefits
• do not place yourself in NAV's decision-making role

NAV's decision is based on multiple sources: medical certificate, employer information, NAV advisor's assessment, any specialist statements. Your role is to provide the best possible medical and functional basis.

When doctors write direct recommendations regarding disability benefits, it can create expectations for the patient that do not align with the regulations, and it can weaken the weight of the statement because it is perceived as an advocacy piece.

Reference list

1. NAV. Medical certificate and specialist certificate. Oslo: The Norwegian Labour and Welfare Administration; 2024. Available from: https://www.nav.no/samarbeidspartner/lege-og-spesialisterklaering
2. The Norwegian Medical Association. Social Security Medicine – 7.1 Introduction to drafting a medical certificate for Nav. Oslo: The Norwegian Medical Association; 2023.
   Available from: https://trygdemedisin.legeforeningen.no/book/m-2660
3. Molteberg Nilsen Law Firm. What are the requirements for a medical certificate when applying for disability benefits? Oslo; 2025. Available from: https://nav-klage.no/artikler/hva-er-kravene-til-legeerklaering-ved-soeknad-om-ufoeretrygd
4. The Norwegian Directorate of Health. Sick leave guide – professional recommendations. Oslo: The Norwegian Directorate of Health; 2024.

• Avoid copy and paste.
• If the situation is unchanged, state it explicitly.
• New information often emerges.

NAV and appeal bodies often see long courses with repeated declarations. When text is reused uncritically:

• it becomes unclear whether a new assessment has actually been made
• important changes (improvement/deterioration) can be overlooked
• trust in the statement is weakened

A short, clear sentence such as "The situation is unchanged since the statement dated…" is better than hidden copy-and-paste. At the same time, there will almost always be something new to say about function, treatment, work situation, or coping (1,2).

Reference list

1. NAV. Medical certificate and specialist certificate. Oslo: The Norwegian Labour and Welfare Administration; 2024. Available from: https://www.nav.no/samarbeidspartner/lege-og-spesialisterklaering
2. The Norwegian Directorate of Health. Medical certificate for incapacity for work – National e-health standard (HIS 80805:2008). Oslo: The Directorate of Health; 2008. Available from: https://www.helsedirektoratet.no/standarder/legeerklaering-ved-arbeidsuforhet
3. The Norwegian Medical Association. Social Security Medicine – 7.1 Introduction to drafting a medical certificate for Nav. Oslo: The Norwegian Medical Association; 2023.
   Available from: https://trygdemedisin.legeforeningen.no/book/m-2660
4. NAV. Medical certificate and specialist certificate. Oslo: The Norwegian Labour and Welfare Administration; 2024.
   Source: NAV's official page

The Norwegian Function Assessment questionnaire was developed specifically to provide a structured, patient-reported measure of functional ability in social security and sick leave contexts. It is based on the ICF and covers (1-3):

• four physical functional areas: walking/standing, holding/picking, lifting/carrying, sitting
• three mental: coping, interacting/communicating, seeing/hearing

In the original study (Brage et al. 2004), the questionnaire was tested on 798 people after six weeks of sick leave.

It showed:

• good correlation with SF-36 and COOP/WONCA
  • SF‑36 is a standardised questionnaire for health-related quality of life. It measures 8 health domains: physical functioning, pain, general health, vitality, social functioning, role emotional, mental health, and role limitations. It is used in research, rehabilitation, and in the assessment of function in sick-listed individuals
  • COOP/WONCA charts are 6 simple, visual forms that measure the patient's self-assessment of function: physical fitness, emotions, daily activities, social life, general health, and change over time. They are quick to use in general practice and are well suited for consultations, sick leave follow-up, and rehabilitation
• clear factors that corresponded with ICF domains
• usability in clinical practice and social security assessment

The form is provided by the general practitioner:

• a concrete starting point for conversation about function
• documentation that can be attached to NAV cases
• a language that matches ICF and NAV's needs

In practice, you can use the form both as:

• a tool in the consultation (the patient fills out, you go through together)
• an attachment that supports your assessments in the medical certificate.

Reference list

1. Brage S, Fleten N, Knudsrød OG, Reiso H, Ryen A. Norwegian Functioning Questionnaire – a new instrument for sick leave and disability assessment. Tidsskr Nor Legeforen.2004;124(20):24722474.
2. NAV. Norwegian Function Form. Oslo: The Norwegian Labour and Welfare Administration; year not specified. Available from:https://www.nav.no/_/attachment/inline/470b2ff0-5200-453a-9873-db74bd6ac642:14063017910289bb108a06232a2872d4425cf280/Norsk%20funksjonsskjema.pdf
3. Norwegian Function Form. Norwegian Function Form – information page. Oslo; year not specified. Available from: https://www.skjema1.eu/
4. WHO. International Classification of Functioning, Disability and Health (ICF). Geneva: World Health Organization; 2001.

The general practice consultation is a structured conversation in which the doctor and the patient together explore a problem, with the aim of understanding both the medical illness, the patient's experience, and the surrounding situation. It combines biomedicine, communication, and clinical judgment in one work process.

The requirement for the doctor is:

• Accurate medical history
• Tentative diagnoses
• Functional description (ICF + Norwegian functional form)
• Advice, treatment, investigation, referral, follow-up

The MSK consultation in general practice is often:

• time-pressured
• complex
• emotionally charged
• systemically important (sick leave, NAV, referral)

A good consultation:

1. Starts with the patient's history – what is most important for the patient now?
2. Forms a working hypothesis – what can explain the complaints?
3. Tests the hypothesis clinically – standardised examinations, functional tests.
4. Connects findings to function – what does this mean for work, everyday life, participation?
5. Clarifies expectations – what does the patient hope for? What is realistic?
6. Makes a plan – treatment, activity, facilitation, possible referral.

When you also think ICF, the consultation becomes more structured: you cover body, activity, participation, and context (1-3).

Reference list

1. Malterud K, Stensland P. Consultation models. Oslo: The Norwegian Medical Association; 2016. Available from:https://www.legeforeningen.no/foreningsledd/fagmed/norsk-forening-for-allmennmedisin/Kurs-og-kvalitetsarbeid/legekunst-i-praksis/konsultasjonsmodeller/
2. The Norwegian Directorate of Health. general practice approach – clinical learning objectives. Oslo: The Norwegian Directorate of Health; 2020. Last professionally updated: August 31, 2020. general practice approach – The Norwegian Directorate of Health
3. Bruusgaard D, Braut GS. Consultation. Store Medical Encyclopedia; updated November 25, 2024. Available from: https://sml.snl.no/konsultasjon

A final oral exam in general practice in medical school is actually a distillation of good clinical practice that the student is expected to be familiar with and able to practice (1-3):

• preparation
• patient-centered history taking
• structured examination
• clinical reasoning
• plan and follow-up

In the MSK field, it is particularly important to:

• avoid chasing a single pathoanatomical explanation when the picture is complex
• look for red flags (serious pathology) and yellow flags (psychosocial risk factors)
• explicitly assess work and function, not just pain

This is also the core of modern guidelines for back and neck pain.

Reference list

1. Lærum E, Brox JI, Storheim K, Espeland A, Haldorsen E, Rossvoll I, et al. National clinical guidelines for low back pain – with and without nerve root involvement. Short version. Oslo: Information Unit for Musculoskeletal Disorders/Social and Health Directorate; 2007. Available from: https://www.oslouniversitetssykehus.no/4aa730/contentassets/311942ce0b2c450ea062c42789a4b7b5/dokumenter/brosjyrer/kortversjon_nasjonale-kliniske-retningslinjer-for-korsryggsmerter.pdf
2. Lærum E, Brox JI, Storheim K, Espeland A, Haldorsen E, Rossvoll I, et al. National clinical guidelines for low back pain – with and without nerve root involvement. Oslo: Information Unit for Musculoskeletal Disorders/Social and Health Directorate; 2007. Available from: http://manuellterapi.no/wp-content/uploads/sites/125/2017/05/Nasjonale-kliniske-retningslinjer-for-korsryggsmerter-med-og-uten-nerverotaffeksjon.pdf
3. Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018;391(10137):2368–2383.
4. Heier I. Interdisciplinary neck and back treatment. Oslo: The Health Library; 2025.
   Last professionally updated: 16 September 2025. Available from: https://www.helsebiblioteket.no/innhold/retningslinjer/veileder-i-fysikalsk-medisin-og-rehabilitering/plager-i-nakke-og-rygg/tverrfaglig-nakke-og-ryggbehandling

Smart Choices is the Norwegian version of the Choosing Wisely campaign. It aims to reduce overdiagnosis and overtreatment by providing professional recommendations on examinations and treatments that often provide no benefit and can cause harm (1-3). The goal is for doctors and patients together to make better decisions regarding diagnostics and treatment. Furthermore, it promotes specific recommendations on what should be avoided when it does not provide health benefits or can harm the patient. The campaign also aims to reduce unwanted variation, unnecessary tests, and medical overactivity.

In the MSK field, this is particularly relevant for:

• imaging diagnostics (MRI, CT, X-ray)
• surgery for nonspecific back and neck pain
• long-term passive treatment without documented effect

Overdiagnosis can create:

• unnecessary worry
• sick role
• unnecessary treatment

Over-investigation can:

• delay useful measures
• reinforce disease focus
• waste resources

Over-treatment can:

• cause side effects
• create dependency (e.g., opioids)
• make the patient more passive

Reference list

1. Norwegian Radiological Society. Make wise choices – Radiology. Oslo: The Norwegian Medical Association; 2018. Available from: https://www.legeforeningen.no/foreningsledd/fagmed/norsk-radiologisk-forening/artikler/fag-og-utdanningsstoff-fra-noraforum/gjor-kloke-valg-radiologi/
2. Nomme F, Jarosch-von Schweder GK, Andersen ER, Brandsæter IØ, Kjelle E, Hofmann B. Smarter referral for imaging diagnostics. Tidsskr Nor Legeforen. 2022;142(10). Available from: https://tidsskriftet.no/2022/06/fra-fagmiljoene/klokere-henvisning-til-bildediagnostikk
3. NTNU Department of Health Sciences. Reference info – More is not always better. Trondheim: NTNU; 2022. Available from: https://www.ntnu.no/ihg/henviserinfo
4. Choosing Wisely International. Musculoskeletal recommendations. Ottawa: Choosing Wisely; year not provided.

International and Norwegian data show:

• large variation in the use of MRI and CT between countries
• significant overuse of imaging diagnostics for non-specific MSK complaints
• small correlation between many imaging findings (e.g., degenerative changes) and the patient's pain and function

OECD data shows that Norway has relatively high MRI use per 1000 inhabitants, along with countries such as the USA, Germany, and Switzerland. At the same time, we know that a significant proportion of the examinations do not change treatment (1-4).

The Norwegian Directorate of Health's guidelines (IS-1899) for non-traumatic MSK disorders recommend:

• to avoid imaging for non-specific low back pain without red flags
• to wait 4–6 weeks MRI for suspected herniated disc, unless there are severe neurological deficits
• to use MRI for knee and shoulder complaints only after conservative treatment has been tried and there are mechanical symptoms (locking, effusion, locking tendency)

The consequences of overuse are:

• resource use (hundreds of millions annually)
• waiting time for patients who actually need MRI
• increased risk of overdiagnosis and unnecessary surgery

For the general practitioner, this means:

• a good clinical examination and functional assessment are more important than ‘being on the safe side’ with MRI
• safe, knowledge-based communication is necessary to manage the patient's expectations

Reference list

1. Lærum E, Brox JI, Storheim K, Espeland A, Haldorsen E, Rossvoll I, et al. National clinical guidelines for low back pain – with and without nerve root involvement. Short version. Oslo: Information Unit for Musculoskeletal Disorders/Social and Health Directorate; 2007. Available from: https://www.oslo-universitetssykehus.no/4aa730/contentassets/311942ce0b2c450ea062c42789a4b7b5/dokumenter/brosjyrer/kortversjon_nasjonale-kliniske-retningslinjer-for-korsryggsmerter.pdf
   Source: OUS publication
2. Lærum E, Brox JI, Storheim K, Espeland A, Haldorsen E, Rossvoll I, et al. National clinical guidelines for low back pain – with and without nerve root involvement. Oslo: Information Unit for Musculoskeletal Disorders/Social and Health Directorate; 2007. Available from: http://manuellterapi.no/wp-content/uploads/sites/125/2017/05/Nasjonale-kliniske-retningslinjer-for-korsryggsmerter-med-og-uten-nerverotaffeksjon.pdf
3. Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018;391(10137):2368–2383.
4. Heier I. Interdisciplinary neck and back treatment. Oslo: The Health Library; 2025.
   Last professionally updated: 16 September 2025. Available from: https://www.helsebiblioteket.no/innhold/retningslinjer/veileder-i-fysikalsk-medisin-og-rehabilitering/plager-i-nakke-og-rygg/tverrfaglig-nakke-og-ryggbehandling

Studies of referrals to back clinics and other MSK units show (1-3):

• many referrals lack clinical findings
• many referrals lack information about function, work, treatment
• MRI is often taken without there being a clinical question that justifies it

A good referral:

1. Has a clear purpose: What do you want an answer to? What are you wondering about?
2. Summarizes the medical history briefly and precisely: onset, duration, course, treatment, function, work.
3. Describes clinical findings: inspection, mobility, neurology, provocation tests.
4. Indicates function and work: what the patient can do, what they cannot do, what the work situation is like?
5. Identifies relevant additional investigations: blood tests, X-ray, MRI, previous assessments.

When the referral is good:

• the prioritization becomes more accurate
• the investigation becomes more targeted
• the patient avoids unnecessary examinations
• The cooperation between levels improves

Reference list

1. The Norwegian Directorate of Health. Referral guide – national guide for referrals to specialist healthcare services. Oslo: Norwegian Directorate of Health; 2015. Last professionally updated: August 6, 2018. Available from: https://www.helsedirektoratet.no/veiledere/henvisningsveileder
2. The Health Library. National guide for referrals to specialist healthcare services. Oslo: The Health Library; 2015. Last professionally updated: November 2, 2015. Available from: https://www.helsebiblioteket.no/innhold/nasjonale-veiledere/henvisninger-til-spesialisthelsetjenesten
3. The Norwegian Directorate of Health. Prioritization guides for 33 subject areas in specialist healthcare services. Oslo: Norwegian Directorate of Health; 2015.
4. TSB Norway. Referral and rights assessment in interdisciplinary specialized substance abuse treatment (TSB). Oslo; year not specified. Available from: https://tsbnorge.no/henvisning-og-rettighetsvurdering