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. Addictions Referral Form
Diabetes Education Nurse *they may request you involve the endocrinology team: Diabetes Education Nurse Referral Form
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. Hepatology Referral Form
Palliative Care: Palliative Care Referral Form
Psychiatry: Monday-Friday (9am-5pm): Page Brock Cooper, NP (416-685-9046). On evenings and weekends, page Psychiatry on call.
Wound Care: Wound Care Referral Form
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.
Rapid Referral Clinic Instructions
Rapid Referral Clinic Referral Form

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.
GIM Clinic Referral Instructions
GIM Clinic Referral Form
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: AKI Clinic Referral Form
Atrial Fibrillation Clinic: AFib Clinic Referral Form
Chronic Pain Clinic: A referral can be faxed to 416-864-5854
Heart Failure Clinic: CHF Clinic Referral Form
Hepatology Clinic: Hepatology Clinic Referral Form
Secondary Stroke Prevention Clinic: Fax: 416-864-5737, Phone: 416-864-6060 Ext. 3576
Thromboembolism Clinic: VTE Clinic Referral Form
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: