Get the free Peterborough Genetics Referral Form Feb 2016.doc

Genetics Program Referral 1 Hospital Drive, Peterborough, ON K9J 7C6 Fax: 7058765129Surname: /Date of Birth: (dd/mm/YYY):/Phone: 7058765185First Name: Health Card Number: Parent/Guardian: Home Phone:

How to fill out peterborough genetics referral form

How to fill out peterborough genetics referral form

1. To fill out the Peterborough Genetics Referral Form, follow these steps:
2. Start by downloading the form from the official website or obtaining a physical copy from the relevant healthcare facility.
3. Read the instructions provided at the beginning of the form carefully to understand the required information and guidelines.
4. Begin filling out the form by providing the patient's personal details such as their full name, date of birth, and contact information.
5. Move on to providing details about the requesting healthcare provider, including their name, address, and contact information.
6. Provide a comprehensive medical history of the patient, including any previous genetic testing, diagnoses, and relevant family medical history.
7. Make sure to accurately fill out the clinical indication section, explaining the reasons for requesting genetic testing or consultation.
8. If applicable, include any additional relevant reports, test results, or supporting documentation.
9. Review the completed form to ensure all the required fields are filled out correctly and legibly.
10. Sign and date the form as indicated, acknowledging that the information provided is accurate to the best of your knowledge.
11. Submit the filled-out form as instructed, either by mailing it to the designated address or delivering it in person to the appropriate healthcare facility.
12. Remember to keep a copy of the filled-out form for your records.

Who needs peterborough genetics referral form?

1. The Peterborough Genetics Referral Form is needed by healthcare providers or clinicians who wish to refer a patient for genetic testing or genetic consultation in the Peterborough area.
2. Patients who have a suspected or confirmed genetic condition and require further evaluation, management, or counseling may also need this referral form.
3. It is important to consult with the specific guidelines and policies of the Peterborough healthcare system to ensure appropriate utilization of the referral form.

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What is peterborough genetics referral form?

The Peterborough Genetics Referral Form is a document used to refer patients for genetic testing or counseling services.

Who is required to file peterborough genetics referral form?

Healthcare providers or specialists who are recommending genetic testing or counseling for their patients are required to file the Peterborough Genetics Referral Form.

How to fill out peterborough genetics referral form?

The form typically requires basic information about the patient, the reason for referral, and any relevant medical history. The healthcare providers can fill out the form electronically or manually.

What is the purpose of peterborough genetics referral form?

The purpose of the Peterborough Genetics Referral Form is to facilitate the process of referring patients for genetic testing or counseling services to ensure appropriate care and support.

What information must be reported on peterborough genetics referral form?

The form may require information such as patient demographics, family history of genetic conditions, reason for referral, primary care provider information, and any relevant medical records.