Get Canada University Health Network Prop Referral Form 2015-2025

Filling out the Canada University Health Network PROP Referral Form online can streamline the referral process for patients requiring palliative radiation oncology services. This guide provides a detailed walkthrough of each section of the form, ensuring that users can complete it accurately and efficiently.

Follow the steps to fill out the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Begin with the patient information section. Fill in the last name, first name, date of birth in the format dd/mm/yyyy, and other details such as gender and health card number.
3. Complete the address fields, including street address, city, province, and postal code. Ensure all phone numbers (home, cell, work) are accurately provided for the patient.
4. Identify if the patient is a previous UHN patient by indicating yes or no.
5. In the referring physician section, input the name, phone number, and fax number of the referring medical professional.
6. Move to the clinical information required section. Copy or email all appropriate notes and reports as specified in the documentation checklist.
7. Select the reason for consultation, such as spinal cord compression or bone metastases, and indicate the symptom burden on a scale from 0 to 10.
8. Provide diagnosis and reason for referral in the designated space.
9. List any symptoms requiring palliation, such as pain or neurological symptoms, by checking the appropriate boxes.
10. Specify the patient's location: whether at home or another facility.
11. Indicate prior or planned therapy including any radiotherapy or chemotherapy details.
12. After completing the form, save changes. You can download, print, or share the completed form as necessary.

Complete your referrals online today for a more efficient process.