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External Referral Form CW omens College Hospital 76 Grenville Street, 3rd Floor Toronto, Ontario M5S 1B2 Phone: 4163236269 Fax: 4163232666Please fax all pages of the referral forms together with requested
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To fill out the WCH Pain Management Centre Referral Form, follow these steps:
02
Begin by providing the patient's personal information, including their name, address, phone number, and date of birth.
03
Next, indicate the referring physician's details, such as their name, contact information, and specialty.
04
Specify the reason for referral in the designated section. Include relevant medical history, any previous treatments or procedures, and the nature of the pain experienced by the patient.
05
If applicable, provide details of any relevant diagnostic tests or imaging studies already performed.
06
Indicate the patient's current medication regimen, including any pain medications being used.
07
Include any relevant information about allergies or adverse drug reactions the patient may have.
08
Lastly, ensure that the referring physician signs and dates the form to validate the referral.
09
Once all the required information is completed, submit the form to the WCH Pain Management Centre as per their specified submission process.

Who needs wch-pain-management-centre-referral-form?

01
The WCH Pain Management Centre Referral Form is needed by healthcare professionals who wish to refer their patients to the pain management services offered by the WCH Pain Management Centre.
02
Patients who experience chronic pain or require specialized pain management treatments may also require this referral form to access the services provided by the centre.
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The WCH Pain Management Centre Referral Form is a document used to refer patients to a specialized pain management clinic for assessment and treatment.
Healthcare professionals, such as primary care physicians or specialists, are required to file the WCH Pain Management Centre Referral Form for patients who need pain management services.
To fill out the form, provide patient information, details of the pain condition, relevant medical history, and any previous treatments the patient has received.
The purpose of the form is to formally refer a patient to a pain management center, ensuring that they receive appropriate evaluation and treatment for their pain-related issues.
The form must report patient demographics, pain history, previous treatments, current medications, and any additional relevant medical information.
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