Get Outpatient Pre-registration (referral) Information Form Print Form

The Outpatient Pre-Registration (Referral) Information Form Print Form is essential for efficient patient registration. This guide provides step-by-step instructions to help users complete the form accurately and effectively.

Follow the steps to accurately complete the Outpatient Pre-Registration form online.

1. Click the ‘Get Form’ button to obtain the form and access it in the editing interface.
2. Begin by filling in the patient information, which must be completed by the referral source. Start with the legal last name, legal first name, personal health number, date of birth, and gender. All fields marked with an asterisk (*) are required.
3. Next, provide information about the physicians. Include the full names of the family physician, attending physician, and referring physician, along with the referring physician's contact number.
4. For the emergency contact section, fill out the first and last names of the individual (such as a partner or social worker) along with their relationship to the patient and home phone number. If applicable, select 'Yes' for WCB (Worker's Compensation Board) and supply additional information if requested.
5. If WCB is selected, complete the fields for employer name, WCB claim province, WCB claim number (if available), occupation, work/cellular number, and date of accident.
6. Proceed to the clinic information section, which includes fields that will be completed by the Calgary Health Region. Users may need to fill in the appointment date and time in the 24-hour clock format, the reason for the visit/referral, and contact details for the clinic.
7. Once all fields are filled out, review your information for accuracy. Then save your changes, and you may choose to download, print, or share the completed form as necessary.

Complete your Outpatient Pre-Registration form online today for a smoother registration experience.