Get Download The Referral Form - University Of Ottawa Heart Institute

Filling out the Download The Referral Form for the University of Ottawa Heart Institute is an essential step for facilitating proper referrals for cardiac care. This guide will provide you with clear, step-by-step instructions to help ensure the form is completed accurately and efficiently.

Follow the steps to complete the referral form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by selecting the type of referral — either 'Physician office referral' or 'Emergency Department (ED) referral' — by checking the appropriate box.
3. Provide the name of the family physician who is making the referral.
4. Indicate the source of the patient’s health coverage by checking the appropriate box — either 'Ontario Health,' 'Other province,' or 'Other country.'
5. Select the urgency of the referral by choosing one option — 'Routine,' 'Urgent,' or 'Emergent.'
6. Specify the reason for the referral or chief complaint by marking the relevant checkboxes, and provide additional details if necessary in the space provided.
7. If applicable, indicate whether the patient has seen a Cardiologist at the Heart Institute within the last two years by selecting ‘Yes’ or ‘No,’ and specify further details if 'Yes' is selected.
8. Fill in the patient's cardiac history by checking all that apply, including prior issues such as myocardial infarction or cardiac procedures.
9. List any risk factors related to the patient’s health, marking all that are relevant.
10. Include the patient's height and weight in centimeters and kilograms, respectively.
11. Provide any relevant clinical information, such as recent blood work or medical records, which may assist in the assessment.
12. Sign and print the referring physician's name, along with the date and OHIP billing number at the bottom of the form.
13. Once completed, save changes, and you can choose to download, print, or share the form as necessary.

Complete your referral form online today to ensure timely cardiac care.