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Inpatient Rehabilitation Referral Form 2026
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- Click ‘Get Form’ to open the Inpatient Rehabilitation Referral Form in the editor.
- Begin by filling out the 'Patient Identification' section. Enter the patient's health card number, name, address, and contact details accurately to ensure proper identification.
- In the 'Referral Destination' section, select the appropriate rehab stream by checking either HTSD/Regular stream or LTLD/slowstream based on the patient's needs.
- Complete the 'Patient Details and Demographics' section thoroughly. This includes entering personal information such as date of birth, gender, and primary language spoken.
- Proceed to fill out medical information including allergies, current medical issues, and any ongoing treatments. Ensure all relevant details are included for a comprehensive referral.
- Review all sections for accuracy before submitting. Utilize our platform's features to save your progress and make edits as needed.
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Related links
Please complete the Community Referral and Patient Information forms. Inpatient Rehabilitation Services. People who are at home and would like to be evaluatedRead more
Submit referral form Referral toolkit. Rehabilitation Inpatient Rehabilitation Program 215-590-7458 215-590-5819. Inpatient Rehabilitation Unit.