Written on October 11, 2015.

Referral Forms and more

INPATIENT:

*Most consulting services are paged through locating for a consult, however, see below for services requiring special procedures*

Addictions Services: To make a referral, page 416-692-7539, or call Locating. After hours,fax referral form to ext. 5480. pdf Addictions Referral Form (133 KB)
Diabetes Education Nurse *they may request you involve the endocrinology team: pdf Diabetes Education Nurse Referral Form (189 KB)
Geriatric In-Patient Consultation Service: Page the Acute care of the Elderly (ACE) pager.
Hepatology: We do not have formal liver service; therefore, GI will consult. If a specialized hepatology opinion is needed, a referral needs to be faxed to Dr. Florence Wong and her office needs to be called. Phone: (416) 340-3834, Fax: (416) 340-5019. document Hepatology Referral Form (28 KB)
Palliative Care: pdf Palliative Care Referral Form (49 KB)
Psychiatry: Monday-Friday (9am-5pm): Page Brock Cooper, NP (416-685-9046). On evenings and weekends, page Psychiatry on call.
Wound Care: pdf Wound Care Referral Form (65 KB)
Dentist referrals: Dr. Ganz- 416-828-0223
Ortho Tech: 416-685-9288

OUTPATIENT:
Rapid Referral Clinic

Refer a patient here if you are discharging them from the Emergency Department and they need to be seen for a GIM issue that needs to be followed up on within 1-3 days.
document Rapid Referral Clinic Instructions (21 KB)
document Rapid Referral Clinic Referral Form (214 KB)

GIM Clinic

Refer a patient here if you are discharging them from the Ward and they need to be seen for a GIM issue that needs to be followed up on within 2-4 weeks.
document GIM Clinic Referral Instructions (19 KB)
document GIM Clinic Referral Form (181 KB)
If a patient that you are discharging from the ward needs to be seen sooner: Call Maureen at 5928 to schedule an appointment for the patient to see you in clinic (this can usually happen within 3-7 days of discharge).

Other Clinics:

Acute Kidney Injury: pdf AKI Clinic Referral Form (101 KB)
Atrial Fibrillation Clinic: pdf AFib Clinic Referral Form (154 KB)
Chronic Pain Clinic: A referral can be faxed to 416-864-5854
Heart Failure Clinic: pdf CHF Clinic Referral Form (132 KB)
Hepatology Clinic: document Hepatology Clinic Referral Form (28 KB)
Secondary Stroke Prevention Clinic: Fax: 416-864-5737, Phone: 416-864-6060 Ext. 3576
Thromboembolism Clinic: pdf VTE Clinic Referral Form (155 KB)
Addictions:
- Rapid Access Clinic – for those who have been in contact with ER or admitted for addictions issues
- Drop in clinics
- http://www.stmichaelshospital.com/programs/mentalhealth/addictions-services.php
Coordinated Addictions Services (through City of Toronto)- 1-855-505-5045
- Clients can speak to an addictions counselor who will assist them in finding the appropriate level of care for their needs. Hours: 9 a.m. to 4:30 p.m., Monday to Friday
- http://http://www.stmichaelshospital.com/pdf/programs/coordinated-access-addiction-services.pdf

Consent Forms:

Diagnostic Imaging Forms:

Other Useful Forms: