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University Health Network The Dr. Robert J. Burns Nuclear Cardiology Patient IDENTIFICATION: M.R.N. #Toronto Western Antinuclear CARDIOLOGY REQUISITION LAB CONTACT INFORMATION:___Date of Birth (dd/mm/yr)
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Ensure you have the necessary information such as name, contact information, referring physician details.
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Submit the completed form via the designated submission method, whether online or in person.

Who needs download referral form?

01
Patients who have been referred by a physician to a specific healthcare service or specialist.
02
Healthcare providers who are referring their patients for further evaluation or treatment.
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