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Outpatient Diabetes Referral eform Fraser Health

Updated September 2020 - New background. Updated June 2016 - The form has been updated for May 2015. The new form will pull the patient's FBS and HbA1c if they are in measurements. Also pulls EDC and medications. Medications are duplicated and will need to be edited to separate diabetes meds from other meds. Link to image of back of page for centre locations and contact information. Web link to FH web page. Two versions, one for primary care and one for specialists to allow proper information to be completed for physicians. GP version has been updated for Pathways, GP version has been updated with 2020 background. JohnY.
FHA Diabetes Health Centre Referral: FHA_Diabetes_DHC_GP_V7_Sep27_2020.zip
Updated with Jul2020 background! Some sites (JPOCSC) still insist on using a 2012 version which has a line to request Endocrinologist referral. The current Jul2020 form only has IntMed referral at ARH. Oscar BC has kindly added Endo referral in the event other sites wish it! May need tweaking if your lab requisition has different name than 1.1 Lab requisition. Your OSP can help. JohnY Fix location file and signature reload. Thanks to JohnR for debugging.
FHA Outpatient Diabetes referral png file
new background July 2020, for identification purposes

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