Get St. Michael's General Internal Medicine Clinic Referral Form

Filling out the St. Michael's General Internal Medicine Clinic Referral Form online can streamline the referral process for your healthcare needs. This guide provides step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the referral form online.

1. Press the ‘Get Form’ button to access the referral form and open it in your preferred editing tool.
2. Begin by entering the date in the designated field at the top of the form, ensuring it reflects the current day.
3. Fill in the patient's name, ensuring you input their full legal name as it appears on their health documents.
4. Provide the patient's complete address, including street name, city, province, and postal code.
5. Enter the patient’s contact number(s) where they can be reached for any follow-up appointments or inquiries.
6. Input the patient's email address accurately for any necessary electronic communication from the clinic.
7. Include the patient’s health card number to verify their eligibility for services covered under provincial health insurance.
8. Indicate the patient’s date of birth to confirm their identity and ensure appropriate care.
9. Describe the diagnosis clearly in the specified field, providing enough detail to assist the referral process.
10. State any pending investigations in the designated area to keep the referring clinic informed of the patient's conditions.
11. Remember to attach results of all relevant investigations to the referral to provide comprehensive information for the clinic.
12. Indicate if assistance is needed for the patient by checking the appropriate boxes for translator or hearing impairment requirements.
13. Complete the referring medical doctor’s details, including their name, signature, office address, OHIP billing number, and contact information.
14. If the primary care provider differs from the referring doctor, include their details in the specified section.
15. Once all fields are filled, make sure to review the form for accuracy before saving changes or printing it for submission.

Complete your referral form online today for a seamless experience in accessing the necessary healthcare services.