Get Alberta Thoracic Oncology Program Referral Form

This guide provides users with a comprehensive overview of how to complete the Alberta Thoracic Oncology Program Referral Form online. Designed to be user-friendly, this step-by-step instruction will assist users in accurately filling out the necessary information for their referral.

Follow the steps to successfully complete the referral form online.

1. Press the ‘Get Form’ button to access the referral form and open it for editing.
2. Begin with the Referring Physician Information section. Enter the name of the physician making the referral.
3. Next, move to the Patient Information section. Fill in the patient's last name, first name, and date of birth in the format yyyy-Mon-dd.
4. Provide the patient's phone number, home phone, mobile phone, and fax number. Ensure all contact details are accurate.
5. Write the patient's complete address, including city and postal code.
6. If applicable, enter the name of the family physician.
7. For the Reason for Referral section, check all relevant conditions that apply to the patient.
8. In the Brief Clinical/Medical History section, provide a concise summary highlighting the patient's symptoms and relevant medical history.
9. Review the Triage Requirements. Ensure that a current CT scan of the chest is attached, especially if the patient has lung, mediastinal, or suspected metastatic lesions.
10. If sending CT Chest images in physical form, make sure to send them to the specified address provided.
11. If applicable, include the biopsy result for esophageal cancer.
12. Document any medications the patient is currently taking, including the use of oxygen.
13. Finally, if available, attach the allergy list, lab results, microbiology/pathology reports, consultant/discharge letters, diagnostic imaging, and pulmonary function studies.
14. Once all fields are completed, save changes, and decide whether to download, print, or share the form as needed.

Complete your referral form online today to ensure timely processing.