Glen sather referral 2025

1. Click ‘Get Form’ to open the glen sather referral in the editor.
2. Begin by filling out the Patient Information section. Enter the patient's Name, Gender, Date of Birth (DOB), Age, Address, Home Phone Number, Cell Number, and Personal Health Number (PHN). Ensure all fields are completed accurately to avoid delays.
3. In the Clinical Details section, specify the Injury Date and Body Part affected. Indicate whether it is an Acute Injury, Flare-up of a Pre-Existing Condition, or Chronic Condition. Additionally, provide details about the Activity/Sport affected.
4. Clearly articulate the Reason for Referral. Include information on Mechanism of Injury, Present Symptoms, Treatment to Date, and how it affects the individual's Sport/Exercise Participation.
5. If applicable, indicate any Imaging or investigations that have been completed. Check the relevant boxes for X-ray, CT, Ultrasound, MRI, or Bone Scan.
6. Complete the Referring Health Professional Information section by entering your Name (Print), PRACID, Mailing Address, Date, Signature, Phone Number, and Fax Number.
7. Review all entries for accuracy before submitting. Once complete, you can easily send it via fax as instructed.

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