Get the free Medical Genetics Referral Form

PATIENT INFORMATION Name DOB (YYY/MM/DD) SHIP# MEDICAL GENETICS REFERRAL Mailing Address: Medical Genetics Program 76 Stuart Street Connell 4, Kingston ON K7L 2V7 Telephone: 613-548-2467 Toll free:

How to fill out medical genetics referral form

How to fill out a medical genetics referral form:

1. Start by filling in your personal information such as your name, date of birth, and contact details. This will ensure that the medical genetics team can easily reach out to you if needed.
2. Provide a detailed family medical history. Include information about any genetic disorders or conditions that have been diagnosed in your immediate family members, such as parents or siblings. Be sure to mention if there have been any known cases of consanguinity (blood relatives having children together) in your family.
3. Indicate your reason for seeking a medical genetics referral. Clearly explain the specific symptoms or concerns that you or your healthcare provider have identified, which have led to the request for genetic evaluation. This will help the medical genetics team understand your unique situation and prioritize your case.
4. Include any relevant medical test results. If you have undergone any genetic tests or screenings in the past, provide copies of the reports or briefly mention the results in the referral form. This information will assist the medical genetics team in interpreting your test results and making a proper diagnosis or recommendation.
5. Mention any previous consultations with other specialists. If you have sought medical advice from other healthcare professionals, mention their names and specialties in the referral form. This can help the medical genetics team collaborate with other experts to provide comprehensive care and guidance.

Who needs a medical genetics referral form?

1. Individuals who have a family history of genetic disorders or conditions. This includes those with relatives who have been diagnosed with genetic diseases or conditions, as well as cases of consanguinity.
2. Patients exhibiting symptoms or clinical features that may suggest an underlying genetic cause. These symptoms may be physical abnormalities, developmental delays, intellectual disabilities, or other suspected genetic conditions.
3. Couples planning to start a family who want to assess their risk of passing on genetic disorders. This can be particularly important for individuals who have a known family history of genetic diseases or conditions.

Overall, a medical genetics referral form is necessary for individuals and families who require specialized genetic evaluation and counseling. The form ensures that all relevant information is provided to the medical genetics team, allowing them to make accurate diagnoses, discuss potential treatment options, and provide appropriate support and guidance.

For pdfFiller’s FAQs

What is medical genetics referral form?

The medical genetics referral form is a document used to request genetic evaluation and counseling for patients with suspected genetic conditions or risk factors.

Who is required to file medical genetics referral form?

Healthcare providers, such as doctors or genetic counselors, are required to file the medical genetics referral form on behalf of their patients.

How to fill out medical genetics referral form?

To fill out the medical genetics referral form, healthcare providers need to provide detailed information about the patient's medical history, family history, and specific genetic concerns.

What is the purpose of medical genetics referral form?

The purpose of the medical genetics referral form is to facilitate the identification, diagnosis, and management of genetic disorders through genetic evaluation and counseling.

What information must be reported on medical genetics referral form?

The medical genetics referral form must include the patient's personal information, medical history, family history of genetic disorders, and specific reasons for genetic evaluation.

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