Get Queensway Health Centre

Filling out the Queensway Health Centre New Patient Referral Form is a straightforward process. This guide provides comprehensive, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to successfully complete the referral form.

1. Click ‘Get Form’ button to obtain the form and access it in the editor.
2. Begin by filling in the patient's surname and given name. Ensure the data entered is accurate for identification purposes.
3. Enter the patient's date of birth (DOB) in the format of DD/MM/YY. This information is crucial for patient records.
4. Record the patient's health card number. This is required for insurance and billing purposes.
5. Provide the complete address of the patient including street, city, province, and postal code. This ensures correct geographical identification.
6. Fill out the home and work telephone numbers. Contact information helps maintain communication and facilitate appointments.
7. List the referring physician's name along with their billing number, telephone number, and fax number. This allows for proper processing of the referral.
8. If applicable, enter the family physician’s name along with their billing number, telephone number, and fax number.
9. Specify the requested service(s) by selecting the appropriate options for medical oncology or radiation oncology, and indicate new, second opinion, or recurrent/progressive status.
10. If the patient has received previous radiation, indicate 'Yes' and specify the body site. Ensure to include previous records with the referral.
11. Clarify whether the patient is aware of their diagnosis by selecting 'Yes' or 'No'.
12. Indicate if the pathology is available by selecting 'Yes' or 'No'.
13. Provide a detailed reason for the referral in the designated area. Ensure all information is clear and comprehensive.
14. Attach any required documents such as referral letters, pathology reports, operative reports, or blood work results as indicated in the form.
15. Have the referring physician sign the form and date it. This validates the referral and confirms the information provided.
16. Finally, ensure that all changes are saved, and options to download, print, or share the completed form are utilized as necessary.

Complete your documents online today by following this guide.