Get Juravinski Cancer Centre Referral Form 2020-2025

The Juravinski Cancer Centre Referral Form is an essential document for initiating the referral process for patients seeking cancer treatment. This guide will provide clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to fill out the referral form with ease.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin by entering the patient's name in the designated field. Ensure the correct spelling of the first and last name for accurate identification.
3. Proceed to fill in the health card number or non-OHIP information, followed by the patient's date of birth in the specified format (dd/mm/yy).
4. Indicate the version code, language preference, city, province, and postal code of the patient.
5. Provide both the primary and secondary phone numbers of the patient along with their complete address.
6. Specify the patient’s location as either 'Home' or 'Institution' and include relevant institution details if applicable.
7. Enter information for an alternate contact, including their relationship to the patient and phone number.
8. Fill out the referring physician's details, including fax and phone numbers, followed by the family physician's information.
9. Select the diagnosis, urgency, and additional status fields regarding the patient's health issues.
10. Indicate whether the patient is informed of their diagnosis and list the requested services.
11. Specify the primary site of concern and reason for consultation, such as new diagnosis or second opinion.
12. Provide any comments or additional information, including previous cancer treatments and investigations scheduled.
13. Make sure to collect any previously completed investigations and specify their availability.
14. Before submission, ensure the referring physician signs the form and includes the date of filling.
15. Once you have completed all sections, save your changes, download or print the form, and share it with the appropriate contacts as required.

Complete the Juravinski Cancer Centre Referral Form online today to ensure timely processing of your referral.