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PATIENT INFORMATION2 Champagne Drive (Champagne Center), Toronto, ON M3J 2C5Tel: 4162226160 Fax: 4162229604 www.polyclinic.caREFERRAL Forename:___ Tel:___ Address:___ ___MAYOR___ /___/___ HC#___ VC___
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How to fill out referral form - polyclinic
How to fill out referral form - polyclinic
01
Obtain the referral form from the polyclinic or healthcare provider.
02
Fill out your personal information accurately, including name, contact information, and any relevant medical history.
03
Provide details about the reason for the referral and the specialist or department you are being referred to.
04
Double check the form for any errors or missing information before submitting it to the polyclinic.
05
Keep a copy of the completed referral form for your records.
Who needs referral form - polyclinic?
01
Patients who require specialized medical care or services that cannot be provided by the polyclinic.
02
Patients who have been recommended by their primary care physician or healthcare provider to see a specialist.
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What is referral form - polyclinic?
Referral form - polyclinic is a document that allows patients to be referred from one healthcare provider to another, specifically to a polyclinic for further treatment.
Who is required to file referral form - polyclinic?
Referral forms for polyclinics are usually required to be filed by the referring healthcare provider, such as a general practitioner or specialist.
How to fill out referral form - polyclinic?
Referral forms for polyclinics typically require information about the patient's condition, medical history, and the reason for the referral. This information is usually filled out by the referring healthcare provider.
What is the purpose of referral form - polyclinic?
The purpose of referral form - polyclinic is to ensure that patients receive the appropriate care from a specialist or polyclinic based on their healthcare needs.
What information must be reported on referral form - polyclinic?
Referral forms for polyclinics often require details about the patient's symptoms, tests results, previous treatments, and any relevant medical reports.
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