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This form must be completed by a physician or clinician

This form must be completed by a physician or clinician 2025

This form must be completed by a physician or clinician Preview on Page 1

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The document is an intake referral form for the Adolescent Psychiatry Unit at Kelowna General Hospital, designed for physicians or clinicians to refer youth aged 12-17 who require urgent psychiatric services or planned admissions. It outlines eligibility criteria, including residency in the Interior Health region and specific mental health conditions, while excluding referrals for eating disorders, conduct disorders, developmental disorders, or substance use. The form collects detailed information about the youth, their family, and relevant medical history to facilitate the referral process.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the 'Referring Organization / Hospital Unit' section, including the referral date and contact details. Ensure all information is accurate for effective communication.
Complete the youth's personal information, including their name, date of birth, gender, and address. This data is crucial for identification and follow-up.
Indicate the living situation and legal status of the youth. Select appropriate options to provide context about their guardianship.
Fill in details regarding family awareness of the referral and include contact information for parents or caregivers.
Document any current or past charges with RCMP, as well as significant medical concerns. This information helps assess risk factors.
In the 'Presenting Concerns' section, check all relevant issues faced by the youth. Provide a description to clarify their situation further.
Finally, ensure that you attach any required reports before submitting the form via fax to complete the referral process efficiently.

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This form must be completed by a physician or clinician 2025

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Can a doctor refuse to fill out paperwork?

Who can legally fill out FMLA paperwork?

Which doctor fills out FMLA paperwork?

What if an employee doesnt complete FMLA paperwork?

What is required on a physician order?

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What to do when a doctor refuses to fill out FMLA paperwork?

Is it legal for a doctor to charge to fill out FMLA paperwork?

Can my doctor refuse to fill out FMLA paperwork?

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This form must be completed by a physician or clinician 2025

Here's how it works

How to use or fill out This form must be completed by a physician or clinician with our platform

Complete this form in 5 minutes or less

Got questions?

Can a doctor refuse to fill out paperwork?

Who can legally fill out FMLA paperwork?

Which doctor fills out FMLA paperwork?

What if an employee doesnt complete FMLA paperwork?

What is required on a physician order?

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People also ask

What to do when a doctor refuses to fill out FMLA paperwork?

Is it legal for a doctor to charge to fill out FMLA paperwork?

Can my doctor refuse to fill out FMLA paperwork?

Related links

Try more PDF tools