Get Canada Hennick Bridgepoint Hospital Outpatient Md Clinic Referral Form 2021-2025

Completing the Canada Hennick Bridgepoint Hospital Outpatient MD Clinic Referral Form online is a straightforward process that facilitates patient referrals to specialized medical services. This guide provides a step-by-step approach to ensure that users can efficiently fill out the necessary information.

Follow the steps to successfully complete the referral form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor. This allows you to begin the process of filling out the necessary information.
2. Enter the patient information accurately, including their name, address, date of birth (in dd/mm/yy format), health card number, daytime contact number, and the name of their family doctor.
3. Fill in the version code if provided. This helps in identifying the specific iteration of the form.
4. Provide the emergency contact information, including the name, phone number, and their relationship to the patient. This ensures that the clinic can reach someone in case of urgent needs.
5. Select the service being referred for by marking the appropriate box next to one of the specialties offered such as Endocrinology, General Internal Medicine, Geriatric Psychiatry, Physiatry, or Neuropsychiatry.
6. In the 'Reason for Referral' section, clearly articulate the rationale behind the referral to inform the clinic of the patient's needs.
7. Attach any necessary documentation, including the patient's medical history, recent lab data or diagnostic imaging, relevant specialist consult notes, and a current list of medications and allergies. It is advised to remind patients to bring their medications to their first appointment.
8. Complete the referring physician's information by entering their name, physician billing number, address, and telephone number.
9. Ensure the physician signature and date are filled in at the bottom of the form.
10. Finally, send the completed form by faxing it to 416-461-2089. After submission, the clinic will reach out to the patient directly to arrange an appointment.

Start filling out the Canada Hennick Bridgepoint Hospital Outpatient MD Clinic Referral Form online today!