Get Form Hospital Toronto

This guide provides a comprehensive overview of how to complete the Form Hospital Toronto online effectively. Users will find clear instructions that outline each section of the form to ensure a smooth submission process.

Follow the steps to fill out the Form Hospital Toronto online

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by entering the patient's given name and surname, followed by their birthdate. Ensure that all names are spelled correctly.
3. Input the patient's address details including street, city, postal code, and home phone number. If applicable, include the work phone number as well.
4. Indicate the patient's gender by selecting 'M' for male or 'F' for female. If the patient identifies with a different gender, select 'Other' and specify.
5. Provide the patient's OHIP number, and if applicable, their VC.
6. Answer whether the patient is a smoker. If yes, specify the number of cigarettes smoked per day and the total years they have smoked. If the patient has quit, indicate the number of years smoked and the last year they smoked.
7. Enter the primary contact's information, including their given name, surname, relationship to the patient, and contact number.
8. Complete the referring physician's details including their name, signature (mandatory), physician number, address, telephone, and fax number.
9. Select the type of referral required (Respirologist, Thoracic Surgeon, or Both).
10. Indicate the reason for the referral from the provided list, ensuring to refer to the clinical pathway on the other side of the document.
11. For internal office use, tick the appropriate boxes for the consultation and any investigations booked.
12. To complete the form, ensure all sections are filled accurately and legibly. Save changes, download, or print the form as needed before submitting it.

Complete your Form Hospital Toronto online today and ensure a timely referral process.