Get Canada St. Josephs Health Care London Cardiovascular Investigation Unit Referral Form 2020

Filling out the Canada St. Joseph’s Health Care London Cardiovascular Investigation Unit Referral Form online is a straightforward process. This guide will provide clear and detailed instructions to assist you in completing the form accurately and efficiently.

Follow the steps to successfully complete the referral form

1. Click ‘Get Form’ button to obtain the referral form and open it in your preferred online editor.
2. Begin by entering the patient information. Fill in the surname and given name, date of birth, sex (select either M or F), and health card number. Provide the address, city, postal code, and indicate if the patient resides in a nursing home by selecting 'YES' or 'NO'. Enter the home phone and alternate contact numbers.
3. Complete the date of referral field using the format YYYY/M/D and if applicable, enter the patient's PIN# or J#.
4. Next, fill in the referring physician information. This includes the physician's name, physician number, address, city, postal code, phone number, fax number, and email address. Don’t forget to sign the form.
5. If applicable, provide the name of the family doctor if it is different from the ordering physician.
6. In the 'Reason for Exam/Clinical History' section, provide detailed information regarding the patient's medical history or reason for the referral.
7. Select the required tests by checking the appropriate boxes, such as Echocardiogram or Electrocardiogram. Be sure to note any selections that include options for different durations, such as 24 hour, 48 hour, or 72 hour for Holter Monitor.
8. Indicate whether the patient requires assistance for transfer by selecting the appropriate option: Yes, Non-weight bearing, Partial weight bearing, Pivot transfer, Lift transfer, or No.
9. At the end of the form, inform your patient about their appointment date and time, and ensure they are aware to arrive 20 minutes prior to their scheduled appointment.
10. Review the completed form for accuracy. When satisfied, you can save changes, download, print, or share the form as necessary.

Complete your referral form online today to ensure timely and effective cardiovascular care.