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Saskatchewan Spine Pathway Clinic FAX to Regina 306-766-7551 - sasksurgery-2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the patient information in the designated fields, including Name, HSN, Address, and Phone numbers. Ensure accuracy for effective communication.
- In the 'Back Specific History' section, check the appropriate boxes for pain location and answer questions regarding pain characteristics and previous treatments.
- Provide detailed responses for aggravating and relieving factors of pain. This information is crucial for assessment.
- Complete the 'Back Specific Physical Exam' section by indicating results from movement tests and reflex assessments. Use checkboxes for clarity.
- Fill in the 'Diagnosis and Treatment' section with patterns observed and any co-morbidities. Include comments as necessary.
- Finally, ensure that the referring practitioner's name, discipline, address, signature, and date are filled out before submitting via fax to Regina.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2012 | 4 Satisfied (31 Votes) |
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