Get High Risk Pregnancy Form

Completing the High Risk Pregnancy Form online is a crucial step in ensuring proper care for individuals experiencing high-risk pregnancies. This guide provides clear, step-by-step instructions to help you accurately fill out each section of the form, ensuring all necessary information is submitted for consultation.

Follow the steps to successfully complete the online form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the date at the top of the form to document when the referral is being made.
3. Specify the recipient by including both the name of the Maternal Fetal Medicine Division and the doctors to whom the referral is directed.
4. Fill in the contact information section, which includes providing the patient's name, address, OHIP number, and phone number(s) to facilitate communication.
5. Indicate the reason for referral. Under the 'Reason for Referral' section, provide details in the space provided about why the consultation is necessary.
6. Select the type of referral by marking one of the three options: one-time consultation, shared care, or transfer of care, to clarify the intended service.
7. Complete the clinical information section by filling in gravity/parity and estimated due date (EDD) to give the receiver essential background about the pregnancy.
8. Ensure to attach all relevant antenatal records, ultrasound results, and lab results with the referral, if required, to provide comprehensive context.
9. Sign the form in the 'Referred by' section, ensuring your name and billing number appear where needed for identification and reimbursement purposes.
10. Finalize your submission by saving the form, downloading it for your records, printing it as necessary, or sharing it with the relevant clinic.

Complete your High Risk Pregnancy Form online today to ensure timely care.