Get Occupational Health Referral

Filling out the Occupational Health Referral form online is a straightforward process that ensures individuals receive the necessary occupational therapy services. This guide provides clear instructions to help users complete the form accurately and efficiently.

Follow the steps to fill out the Occupational Health Referral form online:

1. Click ‘Get Form’ button to obtain the Occupational Health Referral form and open it in your preferred editing tool.
2. Begin by entering the date of referral in the designated field at the top of the form.
3. Indicate whether the referral is urgent by checking the appropriate box next to 'Referral Urgent'.
4. Fill in the patient's name and date of birth in the respective fields provided.
5. Provide the patient's address and phone number in the indicated areas.
6. If applicable, include the name of the Power of Attorney (POA) or caregiver, and specify if they are preferred for initial contact.
7. In the 'Referral Source' section, provide your name, credentials, and contact information.
8. Summarize the relevant medical history and background information that is pertinent to the referral.
9. Clearly state the reason for referral and any specific health issues that the patient is experiencing.
10. If applicable, note any chronic conditions and the name and results of any Functional Risk Assessment Tool (FRAT) used.
11. Enter the name of the client's family physician or practitioner for reference.
12. Confirm whether the client and/or POA/caregiver are aware of and consent to the referral.
13. Indicate if there are any safety concerns for the clinician entering the client’s home environment.
14. Select yes or no for the following inquiries: age 50 and over, not receiving CCAC occupational therapy services, history of falls, and socio-economic status.
15. Review all information for accuracy and completeness.
16. Once completed, save your changes, and prepare to download, print, or share the form as required.

Complete your Occupational Health Referral online today!