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Reset FormPlease fax referral form to:COPD & Heart Failure Telehomecare ReferralCentralorPrint Form9057072409Southlake 9058305980If required, Telehomecare staff will fax the referral form to the Primary
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Begin by entering the patient's personal information, such as their full name, date of birth, address, and contact details.
04
Provide relevant medical history, including any existing conditions or illnesses.
05
Specify the reason for referral to Central Southlake LHIN8.
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Include details of any previous treatments or interventions related to the referral.
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The lhin8-thcreferralform-central-southlake-v4-0adocx is needed by healthcare professionals, referring physicians, or other medical providers who wish to refer a patient to the Central Southlake LHIN8 for specialized healthcare services.
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lhin8-thcreferralform-central-southlake-v4-0adocx is a referral form used for initiating healthcare services within the Central Southlake region.
Healthcare providers and professionals referring patients to services in the Central Southlake area are required to file this form.
To fill out this form, complete all required fields accurately, providing patient details, service needed, and any relevant medical history or referrals.
The purpose of this form is to streamline the referral process for healthcare services, ensuring patients receive the necessary care in a timely manner.
Information such as patient identification details, the specific services being requested, and any clinical information that supports the referral must be reported.
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