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Date FOR OFFICE USE ONLY Internal Referral to 1 2 3 Therapist Date // OT PT RN SW FM OPRP V. 2017. 03. Mary Pack Arthritis Program - Victoria Victoria Arthritis Centre 2680 Richmond Rd Victoria British Columbia Canada V8R 4S9 Tel 250-598-2277 Fax 250-598-1900 REFERRAL NAME Surname SEX M F First ADDRESS Primary CITY POSTAL Secondary PHN DOB MM/DD/YYYY ALTERNATE CONTACT Phone Arthritis Dx New Diagnosis Exclusion Criteria 1. Active ICBC or WorkSafeBC Claim 2. Primary soft tissue conditions eg....
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First, you need to obtain the Mary Pack Arthritis Victoria form.
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Read the instructions carefully to understand the requirements.
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Fill in your personal details such as name, address, and contact information.
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Provide relevant medical information related to your arthritis condition.
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Answer all the questions in the form accurately and honestly.
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Patients who want access to educational resources, self-management programs, or support groups for arthritis can benefit from Mary Pack Arthritis Victoria.
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Whether you have recently been diagnosed with arthritis or have been living with the condition for a long time, Mary Pack Arthritis Victoria can provide resources and support tailored to your needs.
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Mary Pack Arthritis Victoria is a non-profit organization dedicated to helping individuals with arthritis by providing support, education, and resources.
Individuals or organizations who have received funding or donations from Mary Pack Arthritis Victoria are required to file reports.
The report must be filled out with information regarding the funds received, activities conducted, and impact on individuals with arthritis.
The purpose of Mary Pack Arthritis Victoria is to support and empower individuals with arthritis through education, resources, and advocacy.
Information such as funds received, activities conducted, and outcomes achieved for individuals with arthritis must be reported.
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