Get Ph: 613-544-2631 Ext

Filling out the Ph: 613-544-2631 Ext form is a critical step in referring patients to the Cancer Centre. This guide will provide clear and detailed instructions to ensure you complete the form accurately and efficiently, helping to facilitate timely patient care.

Follow the steps to fill out the form correctly.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin by filling in the patient information section. Include the last name, first name, date of birth (in yyyy/mm/dd format), and sex. Also, provide the patient's city, province, and postal code.
3. Input the patient's OHIP/version code or other insurance information, along with their address and all relevant telephone numbers, including home, work, alternative contact, and mobile.
4. Indicate whether the patient has any special needs by checking the appropriate boxes for services like oxygen, wheelchair, stretcher, or transfer service.
5. Fill in the primary care provider's details, including name, phone number, and fax. Ensure that the primary care provider is aware of the referral.
6. In the referral information section, specify the primary site of concern, selecting from the provided options such as breast, hematology, or suspected cancer.
7. Enter the reason for referral and provide any relevant protocol or NCT number if applicable.
8. Provide clinical information and indicate whether supporting documents are attached or pending. This includes imaging results, pathology reports, and a detailed referral letter.
9. Complete the referring care provider information with their name, signature, telephone number, fax, email, and relevant dates for appointments.
10. After filling out all sections, review the form for accuracy. You can save the changes, download it for records, print for physical copies, or share as necessary.

Complete your documents online today to ensure swift patient referrals and care.