High-risk pregnancy referral form 2026

1. Click ‘Get Form’ to open the High-risk pregnancy referral form in the editor.
2. Begin by entering the date at the top of the form. This is essential for record-keeping.
3. In the 'To' section, select the appropriate physician from the Maternal Fetal Medicine Division by checking one of the boxes next to their names.
4. Indicate the type of referral by selecting one of the options: One-time consultation, Shared care, or Transfer of care.
5. Fill in the Patient Contact Information section with details such as Name, Address, OHIP number, and Phone number(s). Ensure accuracy for effective communication.
6. Provide Clinical Information including Gravity/Parity and Estimated Due Date (EDD).
7. Clearly state the Reason for Referral in the designated space. Be as detailed as possible to assist in patient evaluation.
8. Remember to note that all antenatals, ultrasounds, and relevant lab results should be forwarded with this referral.
9. Finally, complete the Referred by section with your name and billing number before submitting.

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