Submission Instructions | Code Definitions

Provincial Cath Referral Form for Adult Patients

Please note:

• Fax completed cath-referral form to the Regional Cardiac Care Coordinator at one of the following centres: Regional Cardiac Care Coordinators Contact Information.
• Do not fax the cath-referral form to the Provincial Office but directly to one of the contacts at a cardiac centre listed above.
• This form is for use by referring physicians only; referrals for cath cannot be made by patients or other non-physicians.
• This form can be used for referrals to all Ontario cath centres except those in Hamilton and Ottawa. Contact these cardiac centres directly to obtain the form used by each centre.

Forms

Cath Referral Form - PLEASE FAX TO REFERRAL HOSPITAL - DO NOT FAX TO CCN

Cath Referral Definitions

Frequently Asked Questions regarding the CCN Referral Form