Get Bso Clinical Leader Referral Request - Behavioural Supports Ontario

The BSO Clinical Leader Referral Request form is essential for referring individuals who may benefit from specialized behavioural supports. This guide provides a step-by-step approach to help you accurately complete the online form, ensuring all necessary information is included to facilitate a timely review.

Follow the steps to efficiently complete the referral request process.

1. Click ‘Get Form’ button to obtain the document and open it in your preferred editing tool.
2. In the 'Patient Name' field, clearly enter the full name of the individual being referred.
3. Fill in the 'Date of Birth' with the individual’s birth date, ensuring the format is consistent with standard practices.
4. Indicate the 'Referring Hospital' where the patient is currently located along with the corresponding 'Unit/Ward' and 'Room #'.
5. Provide the name and contact information of the 'Hospital Contact Name' along with their phone number and extension or pager number.
6. In the 'Criteria for Referral' section, check the boxes that apply regarding the presence of cognitive impairment and responsive behaviours.
7. In the 'Reason(s) For Referral' section, check all relevant boxes that describe the behaviours exhibited by the individual.
8. Detail any 'Restraints', if applicable, in the provided space and describe any other relevant reasons for referral.
9. Complete the 'REQUIRED FOR REFERRAL' checklist by confirming the three assessments: Confusion Assessment Method (CAM), pain assessment, and behavioural charting.
10. Provide a description of presenting behaviours in the designated section.
11. Document any interventions that have been trialed, commenting on the effects of each intervention.
12. Confirm whether the role of the Clinical Leader has been explained to the family or power of attorney (POA) and check the corresponding box.
13. Indicate whether the family or POA is aware of the referral and provide consent by checking the appropriate boxes.
14. Record the name and contact number of the family or POA.
15. Sign and date the form in the 'REFERRAL SOURCE SIGNATURE' section.
16. Once all fields are completed, save changes to the document, and print or share it as needed.

Complete your BSO Clinical Leader Referral Request form online today to ensure timely access to essential supports.