Get Canada Lmc Diabetes & Endocrinology Patient Referral Form 2021-2025

This guide provides a clear and comprehensive overview of how to successfully complete the Canada LMC Diabetes & Endocrinology Patient Referral Form online. With step-by-step instructions, you will be equipped to fill out each section accurately to ensure a smooth referral process.

Follow the steps to complete the patient referral form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in your browser.
2. Enter the patient's name in the specified fields, making sure to fill in their first and last names correctly.
3. Provide the date of birth, ensuring to use the format dd/mm/yyyy.
4. Fill in the patient's health number in the designated field.
5. Enter the version code if applicable.
6. Specify any uninsured services, if necessary, by filling in the corresponding number.
7. Complete the address section, including street name, unit number (if applicable), city, postal code, and mobile number, making sure the mobile number is marked as required.
8. Provide an email address, which is also a required field.
9. Indicate the patient's preferred spoken language if it differs from English, as indicated by the automated phone message system.
10. Select the type of consultation required by marking one of the options available such as consultation & shared care or diabetes education only.
11. Include relevant investigations that would be helpful for the referral, as outlined in the form.
12. Indicate if the referral is for a routine or urgent consultation, noting any expectations for processing time.
13. List current medications the patient is taking in the provided section.
14. Provide the name and physician billing number of the referring physician.
15. Have the referring physician sign and date the form.
16. Review all details for accuracy before finalizing.
17. Once completed, save changes, download, print, or share the form as needed.

Complete your documents online now to ensure timely processing and patient care.