Get Vgh Repetitive Transcranial Magnetic Stimulation Program Referral Form (2012). Oasis - Vancouver

Filling out the VGH Repetitive Transcranial Magnetic Stimulation Program Referral Form is a crucial step for patients seeking treatment. This guide provides a clear and comprehensive walkthrough to help users complete the form accurately and efficiently.

Follow the steps to successfully complete the referral form

1. Click the ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by filling in the patient’s name at the top of the form. Ensure the spelling is correct, as this will be used for all official documentation.
3. Provide the date of birth in the specified format. This information is crucial for identification and age verification.
4. Indicate the marital status of the patient by choosing the appropriate option from the list. This helps in understanding the patient's support system.
5. Enter the Personal Health Number (PHN), which is essential for billing and identification purposes.
6. Fill in the date of referral, which would typically be the current date or the date the referral is being made.
7. Select the gender of the patient by marking either 'M' for male or 'F' for female. This information aids in demographic statistics.
8. Complete the patient’s address, ensuring to include street address, city, province, and postal code for accurate communication.
9. Provide contact information, including home, cell, and work phone numbers. This ensures that the clinic can reach the patient for follow-ups.
10. Input the referring physician's name and select their discipline as Family Physician, Psychiatrist, or Other. This information connects the patient to the appropriate healthcare professional.
11. Include the Medical Services Plan (MSP) number for identification purposes related to patient coverage.
12. Fill in the referring physician’s phone and fax numbers to facilitate further communication with the clinic.
13. Describe the presenting problem in detail. If necessary, attach a separate letter or psychiatric assessments to provide additional context.
14. Outline the patient’s psychiatric history thoroughly, including any significant diagnoses and treatment outcomes.
15. Provide details about any substance use, as this is relevant for treatment planning.
16. Indicate if the patient has failed any Electroconvulsive Therapy (ECT) courses by selecting 'yes' or 'no'.
17. Mention any occurrences of suicidal ideation with a 'yes' or 'no' response, which is critical for safety assessment.
18. List any current medical issues, such as headaches, tinnitus, or cardiovascular conditions, and any implanted devices.
19. Provide a current medication list, detailing all medications the patient is taking, including dosages.
20. Outline any past psychiatric medication trials to give context to the patient’s treatment history.
21. List any known drug allergies to ensure that the patient receives safe and appropriate care.
22. Indicate the patient's employment status and provide details if applicable.
23. Include any additional information that may assist in the referral process.
24. Finally, indicate if the patient has a disability by selecting 'yes' or 'no'. This can provide important context for treatment.
25. Once all fields are completed, review the form for accuracy. You can then save changes, download, print, or share the document as needed.

Complete your documents online with confidence and ensure a smooth referral process.