Get North Shore Public Health Perinatal Referral Form - Vancouver

Filling out the North Shore Public Health Perinatal Referral Form online is an essential step in ensuring appropriate healthcare support for prenatal and postpartum individuals. This guide provides clear and comprehensive instructions on how to complete the form effectively and accurately.

Follow the steps to fill out the referral form correctly.

1. Click ‘Get Form’ button to access the document and open it in your preferred online editor.
2. Begin by confirming if the client is aware of the referral by selecting either ‘Yes’ or ‘No’. Remember, Public Health will not reach out if the client is unaware of the referral.
3. Enter the client’s last name and first name in the designated fields.
4. Provide the client’s address, including the number, street name, apartment number (if applicable), city/town, province, and postal code.
5. Fill in the client’s home phone number and marital status.
6. Indicate the client’s primary spoken language and whether they are fluent in English.
7. For prenatal referrals, enter the expected date of birth and the client’s age. In the pregnancy details section, include the gravida (G), term (T), para (P), abortus (A), and living children (L) information.
8. For postpartum referrals, include the date of the baby’s birth and the baby’s birth weight along with the client’s current weight.
9. Identify any concerns by checking all applicable boxes, such as mental health or financial stress. If other concerns are present, please specify them in the comments section.
10. Complete the referring party's information, including their last name, first name, date of referral, signature/title, phone, and fax number.
11. Finally, review all entered information for accuracy before proceeding to save the document. Users can download, print, or share the completed form as needed.

Start filling out the North Shore Public Health Perinatal Referral Form online today to ensure timely support for those in need.