Get Aesophagial

Filling out the Aesophagial form online can seem daunting, but it is manageable with clear guidance. This step-by-step guide will help you navigate each section of the form efficiently.

Follow the steps to complete your Aesophagial form seamlessly.

1. Click ‘Get Form’ button to access the Aesophagial form and open it in your preferred editor.
2. Enter the patient's surname and given name accurately in the designated fields.
3. Fill in the date of referral using the format yyyy/mm/dd.
4. Provide the patient's street address, city, province, and postal code.
5. Include home and work phone numbers for the patient.
6. Input the date of birth in the format yyyy/mm/dd.
7. Select the gender of the patient by checking the corresponding box.
8. Enter the OHIP number in the appropriate field.
9. If a translator is needed, specify the language required.
10. Provide the primary contact's name and phone number.
11. Specify the relationship of the primary contact to the patient.
12. Fax any consultant notes including patient history, blood work, imaging results, and medications to the numbers provided.
13. Indicate the reason for suspicion of lung or esophageal cancer by checking the applicable boxes.
14. If a CT scan has been ordered, check 'Yes' and specify where and when; otherwise, check 'No.'
15. Fill out the patient history and any investigations conducted to date in the designated sections.
16. Complete the section regarding the date of the patient's initial consultation with the referring physician.
17. Ensure the referring physician signs in the designated area and includes their CPSO number.
18. Once all fields are filled out, save any changes. You may then download, print, or share the form as needed.

Complete your Aesophagial online today for a smooth submission process.