Get Juravinski Cancer Centre Referral Form

Filling out the Juravinski Cancer Centre Referral Form online is an essential step in initiating patient referrals for oncology services. This guide will help you navigate through the form's components effectively and ensure you provide all necessary information for a timely review.

Follow the steps to complete the referral form seamlessly.

1. Click the ‘Get Form’ button to obtain the Juravinski Cancer Centre Referral Form and open it for editing.
2. Begin by entering the patient's information. Ensure to fill out all fields under 'Patient Information,' including the patient's name, health card number, date of birth, language preference, contact information, and address.
3. Identify the patient's location as either 'Home' or 'Hospital' and include any necessary additional contact information for an alternate contact if applicable.
4. Fill in the details of the referring physician and family physician, including their names, phone numbers, and fax numbers. This is crucial for communication regarding the patient's care.
5. In the 'Clinical Information' section, provide the diagnosis and indicate if the patient has been informed of their diagnosis. Also, detail the status of any relevant conditions.
6. Select the requested oncology services that apply, such as medical, radiation, or surgical oncology, and indicate the primary site of the diagnosis.
7. Provide a reason for consultation by selecting the appropriate option—whether it is a new diagnosis, recurrent disease, a second opinion, or other pertinent comments.
8. If applicable, denote any previous cancer treatments, including chemotherapy or radiation, and provide details about the facility where such treatments occurred.
9. List any investigations that have been scheduled or completed, making sure to include dates and the testing facilities involved. This information is crucial for the oncologist's assessment.
10. Ensure the signature of the referring physician is included, along with the date of signing to validate the submission.
11. Once all fields are completed carefully, you can save the form, print it for your records, or share it as required. Remember to fax the form along with any related reports to the provided number.

Complete the Juravinski Cancer Centre Referral Form online today to ensure timely and effective patient care.