Get the free Palliative Care Services Referral Form - Ontario Health atHome

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Ontario Health atHome Common Palliative Referral GUIDELINES FOR COMPLETION FieldContent NOTE: Please complete page 1 at minimum and all other fields as neededUrgency of Response Patient Demographics

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What is palliative care services referral?

Palliative care services referral is the process of directing a patient to specialized medical care that focuses on providing relief from the symptoms and stress of a serious illness, with the aim of improving quality of life for both the patient and their family.

Who is required to file palliative care services referral?

Typically, healthcare providers such as physicians, nurse practitioners, or physician assistants are required to file palliative care services referrals. In some healthcare systems, patients or their family members may also initiate the referral process.

How to fill out palliative care services referral?

To fill out a palliative care services referral, the healthcare provider must complete a referral form that includes patient demographics, medical history, current symptoms, and specific needs for palliative care. The provider should ensure all required information is accurately filled out before submitting it to the palliative care team.

What is the purpose of palliative care services referral?

The purpose of a palliative care services referral is to ensure that patients with serious illnesses receive comprehensive support that addresses not only their medical needs but also their emotional, social, and spiritual needs, enhancing overall quality of life.

What information must be reported on palliative care services referral?

Palliative care services referral must include information such as the patient's name, contact information, diagnosis, treatment history, current medications, specific symptoms or concerns that warrant palliative care, and any advance care planning documents.

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