Get Complex Wound Clinic Referral Form Vancouver General

Filling out the COMPLEX WOUND CLINIC REFERRAL FORM is an essential step to ensure proper consultation at Vancouver General Hospital. This guide provides a detailed overview of each section of the form and instructions for completing it accurately in an online format.

Follow the steps to successfully complete the referral form.

1. Press the ‘Get Form’ button to access the referral form and open it in the designated online editor.
2. Begin by entering the date on which you are filling out the form in the DATE field.
3. In the PATIENT field, provide the full name of the person being referred.
4. Enter the BIRTHDATE of the patient in the designated field.
5. Fill in the PHN (Personal Health Number) to identify the patient within the healthcare system.
6. Indicate the patient’s PIX ID NUMBER in the appropriate field if applicable.
7. Complete the ADDRESS field with the patient's full mailing address.
8. Provide the HOME PHONE and ALTERNATE PHONE numbers for the patient.
9. In the REASON FOR REFERRAL section, clearly describe the reason for the referral, including any pertinent details.
10. Specify the LOCATION OF WOUND and fill out additional sections regarding the nature of the wound, such as traumatic or postoperative failures.
11. Record the Wound Size and Wound Depth where indicated.
12. Document any Previous Treatments used to address the wound in the given section.
13. Answer the questions regarding the patient's mobility, MRSA status, need for an interpreter, and spoken language by checking either Yes or No.
14. Provide a detailed Wound History in the designated area.
15. Fill in the REFERRING DOCTOR’s name and contact information in the final section.
16. After filling out all fields, review the form for accuracy. Once confirmed, save changes, download, print, or share the completed form as needed.

Complete your referral form online today to ensure prompt consultation for your patient.