Created at the request of the Chilliwack Division of Family Practice and Dr. Richard Darby. Referral to the Fraser Health Overdose Outreach Team. Please be aware – there are 2 email links and they are not the same. The first requests a call back to the office (with the name of the physician, the clinic phone number, and the name of the clinic embedded in the email) to discuss a possible referral. The second is to send off a referral form.

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ADULT (18-64) NON-URGENT CONSULTATION SERVICE MENTAL HEALTH AND ADDICTIONS REFERRAL FORM.

Our program provides an interprofessional, collaborative service between London Health Sciences Centre (LHSC) and St. Joseph’s Heath Care (SJHC) London. Our goal is to provide an urgent, consultative care model for clients with limited follow-up and to coordinate access to available resources within LHSC and the community, as appropriate.

Our program provides an interprofessional, collaborative service between London Health Sciences Centre (LHSC) and St. Joseph’s Heath Care (SJHC) London. Our goal is to provide an urgent, consultative care model for clients with limited follow-up and to coordinate access to available resources within LHSC and the community, as appropriate.

This eForm is protected by the GNU General Public License version 2 (GPLv2) You may copy and distribute verbatim copies of the Program’s source code as you receive it, in any medium, provided that you conspicuously and appropriately publish on each copy an appropriate copyright notice and disclaimer of warranty; keep intact all the notices that refer to this License and to the absence of any warranty; and give any other recipients of the Program a copy of this License along with the Program.

Created at the request of David Price. The MENTAL HEALTH & ADDICTIONS OUTPATIENT CLINIC REFERRAL for Humber River Hospital. The first page of this form is information only. It is not included in the main eForm, however, it is in the side menu AND there is a link that can be used with CTRL + P to print out the page. This eForm includes the new Javascript references and the new Xbox and Radio code. Page 2 also has a PHQ9 calculator side menu that will paste to the symptoms input, or alternately at the bottom of the side menu you can click to copy the previous PHQ9 (if you have set up your measurements to store that data) and it will again paste to the symptoms input.

This eForm is protected by the GNU General Public License version 2 (GPLv2).