Get Department Of Ophthalmology Referral Form - Fax To 613 - Cheo

Filling out the Department Of Ophthalmology Referral Form is a crucial step in ensuring timely and effective patient care. This guide will provide you with clear and detailed instructions on how to complete the form accurately and efficiently online.

Follow the steps to effectively fill out the referral form.

1. Press the ‘Get Form’ button to obtain the referral form and open it in your online editor.
2. Begin by entering the patient’s name in the designated field. Provide their date of birth in the format dd/mm/yy, followed by their health card number.
3. Fill in the home phone number, and if applicable, one alternate phone number and a second alternate phone number in the provided fields.
4. Complete the mailing address section, including the city, province, and postal code.
5. In the referring physician/optometrist section, enter the name of the referring provider and their billing number.
6. If different from the referring physician, add the primary care medical doctor or community eye care optometrist/medical doctor.
7. Choose the reason for the consultation. Check the appropriate boxes regarding the condition, including decreased red reflex, trauma, nasolacrimal duct obstruction, chalazion, and amblyopia.
8. For the listed reasons, provide any necessary details as prompted in the form, such as duration of symptoms and treatment history.
9. Confirm if the patient has spectacle correction and has undergone occlusion therapy if relevant, by checking the appropriate boxes.
10. Include any additional details that may assist in triaging the referral by writing them in the designated area.
11. If further information is required, anticipate that the referral may be faxed back with questions, which should be noted in the appropriate section.
12. Finally, print your name, sign the form, and add the date in the provided fields before submitting the form by fax.

Complete your forms online to ensure your referral is processed promptly!