Get the free PAEDIATRIC Referral Form - Algoma Public Health

Genetic Counselling Clinic Pediatric Referral Form Telephone: (705) 942-4646 x3123 ? Fax: (705) 759 5789 294 Willow Avenue ? Salt Ste. Marie, ON P6B 0A9 Website: www.algomapublichealth.com Date of

How to fill out paediatric referral form

How to fill out a paediatric referral form:

1. Start by carefully reading the instructions provided on the form. Make sure you understand the purpose and requirements of the referral.
2. Fill out your personal details accurately in the designated fields. This may include your name, contact information, date of birth, and any relevant identification numbers.
3. Provide a brief description of the reason for the referral. Include any symptoms or concerns that have prompted the need for a paediatric specialist.
4. Indicate the preferred paediatric specialist or clinic you wish to be referred to, if applicable. If you don't have a specific preference, leave this section blank or mention any specific requirements you may have.
5. Include relevant medical history, allergies, and current medications being taken by the child. This information can assist the specialist in providing appropriate care.
6. If the referral is for a specific condition or diagnosis, provide any relevant test results, reports, or documentation that supports the referral.
7. If required, obtain necessary signatures from healthcare providers or guardians, ensuring that all consent forms are completed and attached.
8. Double-check all the information provided on the form for accuracy and legibility. Any errors or missing details could result in delays or confusion.
9. Once the form is complete, submit it to the appropriate person or department as instructed. Keep a copy of the form for your records.

Who needs a paediatric referral form?

1. Patients who require specialized medical care for children, ranging from newborns to adolescents, may need a paediatric referral form.
2. General practitioners or primary care physicians may initiate the referral if they believe that the child's condition requires the expertise of a paediatric specialist.
3. Parents or legal guardians may also request a paediatric referral form if they have concerns about their child's health or development. They may wish to consult a paediatrician or a specific paediatric specialist for a second opinion or specialized treatment.
4. Other healthcare providers who have been involved in the child's care, such as therapists or specialists from other fields, may also request a paediatric referral form to ensure collaborative and comprehensive care.
5. In some cases, schools or educational institutions may require a paediatric referral form for children with specific medical or developmental needs, such as for special education services or accommodations.

For pdfFiller’s FAQs

What is paediatric referral form?

The paediatric referral form is a document used to refer a child or adolescent to a specialist or healthcare provider who has expertise in paediatric care.

Who is required to file paediatric referral form?

Any healthcare provider, such as a general practitioner or pediatrician, who believes that a child or adolescent requires specialized care or treatment, is required to file the paediatric referral form.

How to fill out paediatric referral form?

To fill out the paediatric referral form, the healthcare provider needs to provide information about the patient, including their personal details, medical history, reasons for referral, and any relevant test results or diagnostic information.

What is the purpose of paediatric referral form?

The purpose of the paediatric referral form is to ensure that a child or adolescent receives appropriate and specialized care by referring them to a healthcare provider who has expertise in paediatric care.

What information must be reported on paediatric referral form?

The paediatric referral form typically requires information such as the patient's name, age, contact details, medical history, reasons for referral, any relevant test results or diagnostic information, and the referring healthcare provider's details.

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