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Specialized Geriatric Medicine Service St. Mary's General Hospital 911 Queens Blvd. Kitchener, ON N2M 1B2 Telephone 519 7496929 Fax 519 7496566 Geriatric Clinics Referral Form Acute Geriatric Clinic

How to fill out geriatric assessment referral form

How to fill out geriatric assessment referral form:

1. Start by providing your personal information such as your name, date of birth, address, and contact details. This is essential for identification purposes and to ensure that the assessment is linked to the correct patient.
2. Next, indicate the reason for the referral. Specify the particular concerns or issues that necessitate a geriatric assessment. This can include physical health concerns, cognitive impairments, or mental health conditions.
3. Provide a detailed medical history, including any diagnoses, medications, and past medical procedures. It is important to include relevant information about chronic conditions, hospitalizations, surgeries, allergies, and current medications, as these can impact the assessment process.
4. Include information about any recent or ongoing symptoms or changes in health status. This can include changes in mobility, falls, changes in memory or cognition, changes in mood or behavior, or any other relevant symptoms that may be of concern.
5. Indicate any existing support systems or caregivers involved in the patient's care. This includes information about home care services, family members, or any other individuals who assist in the patient's daily activities and care.
6. Specify any additional assessments, tests, or screenings that have already been conducted or that are pending. This includes laboratory tests, imaging studies, psychological evaluations, or any other relevant assessments that may be required for a comprehensive geriatric assessment.
7. Finally, sign the referral form and provide your contact information, including your name and contact number. This allows the assessing team to reach out to you if they require any additional information or clarification.

Who needs geriatric assessment referral form:

1. Older adults who are experiencing changes in their physical or mental health and require a comprehensive assessment to identify and address their needs.
2. Family members or caregivers who are concerned about an older adult's well-being and believe a geriatric assessment is necessary to better understand their health and support needs.
3. Healthcare professionals, such as primary care physicians or specialists, who feel that an older adult would benefit from a comprehensive geriatric assessment to evaluate and manage their complex health conditions more effectively.

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What is geriatric assessment referral form?

The geriatric assessment referral form is a document used to refer elderly patients for a comprehensive assessment of their physical, mental, and social well-being.

Who is required to file geriatric assessment referral form?

Healthcare professionals such as doctors, nurses, social workers, and caregivers are required to file the geriatric assessment referral form for elderly patients.

How to fill out geriatric assessment referral form?

The geriatric assessment referral form can be filled out by providing the patient's personal information, medical history, current medications, and any specific concerns or symptoms.

What is the purpose of geriatric assessment referral form?

The purpose of the geriatric assessment referral form is to ensure that elderly patients receive a comprehensive assessment of their physical, mental, and social well-being in order to provide appropriate care and support.

What information must be reported on geriatric assessment referral form?

The geriatric assessment referral form must include the patient's personal information, medical history, current medications, any known allergies, and any specific concerns or symptoms.