Get Canada Scarborough Health Network Centralized Intake Mental Health Outpatient Programs Referral Form 2020-2025

Filling out the Canada Scarborough Health Network Centralized Intake Mental Health Outpatient Programs Referral Form online can be a straightforward process when approached with clear guidance. This comprehensive guide offers step-by-step instructions to ensure that all necessary information is accurately provided for effective processing of your referral.

Follow the steps to successfully complete the referral form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the date in the specified field, ensuring to use the correct format.
3. Fill in the demographic information section, including the patient’s name (last and first), preferred name, date of birth, gender, OHIP number, address, city, postal code, primary phone number, secondary phone number, and email.
4. In the presenting concerns section, check all relevant boxes to indicate the nature of the referral, including diagnostic clarification, medication review, or second opinion.
5. Indicate whether this is a new request or a re-referral and fill in any internal referrals if applicable.
6. Clearly articulate the referral goal and describe the presenting problems, current symptoms, and urgency, noting the timeline of concern.
7. If the patient is currently receiving treatment, provide the name, discipline, and type of treatment for the provider.
8. Indicate whether the patient has ever been assessed by a psychiatrist, and provide relevant psychiatric consult notes if available.
9. List current medications and any past medications along with side effects and reasons for discontinuation. Attach a comprehensive list of all relevant medications and diagnostics.
10. Note any known medical conditions or allergies and provide specific details if applicable.
11. Indicate any factors contributing to the current referral by checking relevant boxes such as suicidal risk, recent emergency department visit, or legal involvement.
12. Complete the physician information section, including the referring physician's name, telephone number, billing number, and fax number.
13. Ensure to review all provided information for completeness and legibility, as incomplete referrals may delay service.
14. Once all sections are completed, save changes, and prepare to download, print, or share the form.

Complete your referral form online today to ensure timely access to mental health services.