Get the free Complex Care Clinic Referral Form - Sickkids - hospital

LAST NAME 555 University Ave Toronto, Ontario M5G 1×8(FIRST)DATE OF BIRTHSEXMRNYY MM DD ADDRESSPaediatric Medicine Complex Care Clinic Referral Former: 4168136617 Fax: 41681372381. REVISIT REQUIREMENTS:

How to fill out complex care clinic referral

How to fill out complex care clinic referral

1. Obtain the referral form from the complex care clinic or the referring healthcare provider.
2. Fill in the patient's personal information such as name, date of birth, and contact details.
3. Provide the patient's medical history, including any relevant diagnoses, symptoms, and previous treatments.
4. Specify the reason for the referral to the complex care clinic, highlighting the complexities or unique needs that require specialized care.
5. Indicate any supporting documents or test results that should accompany the referral.
6. Include the referring healthcare provider's contact information, including name, clinic/hospital name, address, and phone number.
7. Review the completed referral form to ensure all necessary information is included and legible.
8. Submit the referral form to the complex care clinic via the preferred method, such as fax, email, or in-person delivery.
9. Keep a copy of the referral form for your records and follow up with the complex care clinic if needed.

Who needs complex care clinic referral?

1. Complex care clinic referrals are typically needed for patients with complex medical conditions or multiple chronic illnesses that require specialized multidisciplinary care.
2. This may include patients with rare diseases, complicated treatment regimens, or conditions that require coordination of care from various healthcare professionals.
3. Referrals to complex care clinics are also appropriate for patients who have not responded well to previous treatments or require a comprehensive evaluation and management plan.
4. Ultimately, the need for a complex care clinic referral should be assessed by the referring healthcare provider based on the patient's medical complexity and individual needs.

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What is complex care clinic referral?

A complex care clinic referral is a process where a patient is referred to a specialized clinic that can provide comprehensive medical care for complex medical conditions.

Who is required to file complex care clinic referral?

Complex care clinic referral may be filed by healthcare providers, primary care physicians, or specialists who believe that a patient's medical condition requires the expertise of a specialized clinic.

How to fill out complex care clinic referral?

Complex care clinic referral can be filled out by providing the patient's medical history, current medical condition, and any relevant test results to the specialized clinic.

What is the purpose of complex care clinic referral?

The purpose of complex care clinic referral is to ensure that patients with complex medical conditions receive appropriate and comprehensive medical care from a specialized clinic.

What information must be reported on complex care clinic referral?

Information such as the patient's medical history, current medical condition, and relevant test results must be reported on a complex care clinic referral.