Get the free Heart Centre Request Form (PDF) - BC Children's Hospital

PRINT Demographic Data OR Stamp Addressograph Reception # BACH MAN: Patient Name (LAST, First): CHILDREN S HEART Center DOB: DD/MM/BY: CLINICAL SERVICES REQUEST Patient Phone #: PhD: *please see reverse

How to fill out heart centre request form

How to fill out a heart centre request form:

1. Begin by gathering all necessary personal information, such as your full name, contact details, date of birth, and address.
2. Fill in your medical history accurately, including any past surgeries, diagnoses, medications, and allergies. Provide as much detail as possible about your current condition or symptoms.
3. Indicate the specific reason for your referral or request for consultation at the heart centre. Describe any relevant symptoms or concerns you may have.
4. If applicable, include any relevant diagnostic test results or reports, such as ECGs, echocardiograms, or X-rays. These can help the healthcare professionals better understand your condition.
5. Make sure to provide any necessary insurance or billing information, as well as preferred payment methods.
6. If you have a preferred healthcare provider or specialist at the heart centre, indicate this in the form, if possible.
7. Check for any additional requirements or attachments requested in the form, such as consent forms or referral letters from your primary care physician.
8. Double-check all the information you've provided before submitting the form to ensure accuracy and completeness.

Who needs a heart centre request form?

1. Individuals who have concerning cardiac symptoms or conditions and require specialized medical care.
2. Patients who have been referred by their primary care physician or other healthcare professionals for further evaluation or treatment at a heart centre.
3. People who have undergone relevant diagnostic tests and need a consultation or second opinion from a cardiac specialist.
4. Individuals with a family history of heart disease or other risk factors who are proactive in managing their cardiovascular health.
5. Patients who have experienced cardiac events or surgeries in the past and require ongoing cardiac care or follow-up.
6. People who are seeking elective cardiac procedures, such as angioplasty or implantation of cardiac devices, and need to go through the appropriate evaluation process.
7. Individuals participating in research studies or clinical trials related to cardiac conditions or treatments that are being conducted at the heart centre.

For pdfFiller’s FAQs

How do I edit heart centre request form online?

pdfFiller allows you to edit not only the content of your files, but also the quantity and sequence of the pages. Upload your heart centre request form to the editor and make adjustments in a matter of seconds. Text in PDFs may be blacked out, typed in, and erased using the editor. You may also include photos, sticky notes, and text boxes, among other things.

How do I edit heart centre request form in Chrome?

heart centre request form can be edited, filled out, and signed with the pdfFiller Google Chrome Extension. You can open the editor right from a Google search page with just one click. Fillable documents can be done on any web-connected device without leaving Chrome.

How can I edit heart centre request form on a smartphone?

The best way to make changes to documents on a mobile device is to use pdfFiller's apps for iOS and Android. You may get them from the Apple Store and Google Play. Learn more about the apps here. To start editing heart centre request form, you need to install and log in to the app.