Get the free Cardio-Obstetrics Clinic Referrall Form - The Ottawa Hospital

CARDIOOBSTETRICS CLINICReferral Form The Ottawa Hospital General Campus 501 Smith Road, Ottawa, ON K1H 8L6 Phone: 6137378582 | Fax: 6137396727 Email: cardiologygen@toh.ca Program Description The CardioObstetrics

How to fill out cardio-obstetrics clinic referrall form

How to fill out cardio-obstetrics clinic referrall form

1. Step 1: Obtain a cardio-obstetrics clinic referrall form from the clinic or download it from their website.
2. Step 2: Fill out your personal information, including your name, date of birth, contact details, and address.
3. Step 3: Provide your medical history, including any previous heart or obstetric conditions, surgeries, or treatments.
4. Step 4: Indicate the reason for the referral and your current symptoms, if any.
5. Step 5: If you have any relevant test results or medical reports, attach copies of them to the form.
6. Step 6: Sign and date the form to acknowledge the accuracy of the information provided.
7. Step 7: Submit the completed referral form to the cardio-obstetrics clinic either in person or through the designated submission method.

Who needs cardio-obstetrics clinic referrall form?

1. Anyone who requires specialized care in the fields of both cardiology and obstetrics may need a cardio-obstetrics clinic referral form. This usually includes pregnant women with existing heart conditions or those who develop heart-related complications during pregnancy or postpartum period. It may also apply to women planning pregnancy with known heart conditions or those identified as high-risk during routine check-ups.

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What is cardio-obstetrics clinic referrall form?

The cardio-obstetrics clinic referrall form is a document used to refer pregnant women with cardiovascular issues to a specialized clinic that can provide both obstetric and cardiac care.

Who is required to file cardio-obstetrics clinic referrall form?

Healthcare providers, such as obstetricians or cardiologists, are required to file the cardio-obstetrics clinic referrall form for their pregnant patients with cardiovascular concerns.

How to fill out cardio-obstetrics clinic referrall form?

The form must be completed with the patient's demographic information, medical history, current cardiovascular issues, and reason for referral. It should be submitted to the designated cardio-obstetrics clinic for review.

What is the purpose of cardio-obstetrics clinic referrall form?

The purpose of the cardio-obstetrics clinic referrall form is to ensure that pregnant women with cardiac issues receive specialized care that addresses both their obstetric and cardiovascular needs.

What information must be reported on cardio-obstetrics clinic referrall form?

The form should include the patient's name, age, gestational age, medical history (including any cardiac conditions), current medications, and reason for referral.