Custom Forms
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Browse all custom forms and eForms in the HFHT Library below
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Custom Forms (New/Updated)
| Form | Form Categories | Subject | EMR | 1st Page Preview | Form Location | Link | Date Modified | hf:doc_categories | hf:doc_tags |
|---|---|---|---|---|---|---|---|---|---|
| 2019 Lab Requisition | Lab Requisitions | MOH | Telus PS |  | Download | 16 December 2024 | lab-requisitions custom-form | moh | |
| Absolute Medical Centre – Chronic Pain Injections | Referrals | Pain | Telus PS |  | Download | 28 November 2024 | referrals custom-form | pain | |
| Absolute Medical Centre – EMG Request | Referrals | EMG | Telus PS |  | Download | 28 November 2024 | referrals custom-form | emg | |
| Abundance Healthcare | Pain | Fibromyalgia, Pain | Ocean eReferral | Ocean Link | 28 November 2024 | pain custom-form | fibromyalgia pain | ||
| Alfa-Scan – Xray and Ultrasound | Imaging | Ultrasound, X-Ray | Telus PS |  | Download | 28 November 2024 | imaging custom-form | ultrasound x-ray | |
| Ancaster Cardiology | Referrals | Cardiology | Telus PS |  | Download | 28 November 2024 | referrals custom-form | cardiology | |
| Ancaster X-ray and Ultrasound | Imaging | Ultrasound, X-Ray | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | ultrasound x-ray | ||
| AVIVA – Allergy Asthma Immunology – Jain/Li | Referrals | Allergy, Asthma, Immunology | Telus PS |  | Download | 28 November 2024 | referrals custom-form | allergy asthma immunology | |
| AVIVA – Allergy, Asthma and Clinical Immunology – Pratt | Referrals | Allergy, Asthma, AVIVA, Immunology | Telus PS |  | Download | 26 February 2025 | referrals custom-form | allergy asthma aviva immunology | |
| Beamsville Diagnostic Imaging | Imaging | imaging | Telus PS |  | Download | 13 February 2025 | imaging custom-form | imaging | |
| BIICE – Burlington IUC & Implant Centre of Excellence | Referrals | IUC | Telus PS |  | Download | 28 November 2024 | referrals custom-form | iuc | |
| BLC Medical Specialists – Burlington | Referrals | Respirology | Ocean eReferral | Ocean Link | 28 November 2024 | referrals custom-form | respirology | ||
| BLC Medical Specialists – Stoney Creek | Referrals | Respirology | Ocean eReferral | Ocean Link | 28 November 2024 | referrals custom-form | respirology | ||
| BounceBack Ontario | Mental Health | Mental Health | Ocean eReferral | Ocean Link | 28 November 2024 | mental-health custom-form | mental-health | ||
| Brantford General Hospital – Medical Imaging | Imaging | BGH | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | bgh | ||
| Brantford Radiology Group – Brant Imaging Clinic | Imaging | BRG, Radiology | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | brg radiology | ||
| Brantford Radiology Group – King George Clinic | Imaging | BRG, Radiology | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | brg radiology | ||
| Brantford Radiology Group – Paris Medical Imaging | Imaging | BRG, Radiology | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | brg radiology | ||
| Brantford Radiology Group – Shellington Imaging Clinic | Imaging | BRG, Radiology | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | brg radiology | ||
| Brantford Radiology Group – St. Paul Imaging Clinic | Imaging | BRG, Radiology | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | brg radiology | ||
| Cardio Study of Hamilton | Imaging | Cardiology | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | cardiology | ||
| Centre for Sleep Disorders | Referrals | Sleep Medicine | Telus PS |  | Download | 28 November 2024 | referrals custom-form | sleep-medicine | |
| Charlton X-ray | Imaging | X-Ray | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | x-ray | ||
| Chronic-Cough Canada | Referrals | Cough | Telus PS |  | Download | 28 November 2024 | referrals custom-form | cough | |
| Compass CHC Caring for My COPD Pulmonary Rehab Program | Imaging | Compass CHC, Pulmonary | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | compass-chc pulmonary | ||
| Compass CHC Diabetes Education Program | Diabetes | Compass CHC | Ocean eReferral |  | Ocean Link | 28 November 2024 | diabetes custom-form | compass-chc | |
| Compass CHC Diabetes Foot Health Program – Brantford | Diabetes | Compass CHC, Diabetes | Ocean eReferral |  | Ocean Link | 28 November 2024 | diabetes custom-form | compass-chc diabetes | |
| Compass CHC Diabetes Foot Health Program – Burlington | Diabetes | Compass CHC, Diabetes | Ocean eReferral |  | Ocean Link | 28 November 2024 | diabetes custom-form | compass-chc diabetes | |
| Compass CHC Diabetes Foot Health Program – Hamilton Mountain | Diabetes | Compass CHC, Diabetes | Ocean eReferral | | Ocean Link | 28 November 2024 | diabetes custom-form | compass-chc diabetes | |
| Compass CHC Diabetes Foot Health Program – Niagara Falls | Diabetes | Compass CHC, Diabetes | Ocean eReferral | | Ocean Link | 28 November 2024 | diabetes custom-form | compass-chc diabetes | |
| Compass CHC Diabetes Foot Health Program – North Hamilton | Diabetes | Compass CHC, Diabetes | Ocean eReferral | | Ocean Link | 28 November 2024 | diabetes custom-form | compass-chc diabetes | |
| Compass CHC Diabetes Foot Health Program – St. Catharines | Diabetes | Compass CHC, Diabetes | Ocean eReferral | | Ocean Link | 28 November 2024 | diabetes custom-form | compass-chc diabetes | |
| Compass CHC Diabetes Foot Health Program – Stoney Creek | Diabetes | Compass CHC, Diabetes | Ocean eReferral | | Ocean Link | 28 November 2024 | diabetes custom-form | compass-chc diabetes | |
| Compass CHC Diabetes Foot Health Program – Welland | Diabetes | Compass CHC, Diabetes | Ocean eReferral | | Ocean Link | 28 November 2024 | diabetes custom-form | compass-chc diabetes | |
| CRA Disability Tax Credit Certificate 2023 | Miscellaneous | Disability | Telus PS |  | Download | 16 December 2024 | miscellaneous custom-form | disability | |
| Crown Point Midwifery | Referrals | Midwifery, Prenatal | Ocean eReferral | Ocean Link | 28 November 2024 | referrals custom-form | midwifery prenatal | ||
| Cytology & HPV Testing Requisition – LifeLabs | Lab Requisitions | cytology, HPV, Lifelabs | Telus PS |  | Download | 28 November 2024 | lab-requisitions custom-form | cytology hpv lifelabs | |
| Direct Care Bayshore – Patient Enrolment & Medical Order Form | Referrals | Telus PS |  | Download | 28 November 2024 | referrals custom-form | |||
| Dundas Medical Imaging | Imaging | Cardiology, Ultrasound | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | cardiology ultrasound | ||
| Dynacare Harmony Prenatal Test | Lab Requisitions | Dynacare, Prenatal | Telus PS |  | Download | 16 December 2024 | lab-requisitions custom-form | dynacare prenatal | |
| ELM Medicine | Referrals | Internal Medicine, Pain | Ocean eReferral | Ocean Link | 28 November 2024 | referrals custom-form | internal-medicine pain | ||
| GHA Surgical Centre | Endoscopy | Referrals | Endoscopy | Ocean eReferral | Ocean Link | 28 November 2024 | referrals custom-form | endoscopy | ||
| GNMI – Hamilton (Nebo Rd) | Imaging | GNMI | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | gnmi | ||
| GNMI – Hamilton (Queenston Rd) | Imaging | GNMI | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | gnmi | ||
| GNMI – Niagara Falls (McLeod Rd) | Imaging | GNMI | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | gnmi | ||
| GNMI – Niagara Falls (Portage Rd) | Imaging | GNMI | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | gnmi | ||
| GNMI – St. Catharines (Linwell Rd) | Imaging | GNMI | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | gnmi | ||
| GNMI – St. Catharines (Pelham Rd) | Imaging | GNMI | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | gnmi | ||
| GNMI – St. Catharines (Welland Ave) | Imaging | GNMI | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | gnmi | ||
| GNMI – Stratford | Imaging | GNMI | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | gnmi | ||
| GNMI – Welland (Prince Charles Dr) | Imaging | GNMI | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | gnmi | ||
| GNMI MRI & CT – Ajax | Imaging | GNMI | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | gnmi | ||
| Haldimand Interim Perinatal Primary Care Clinic | Referrals | Perinatal | Telus PS |  | Download | 24 February 2025 | referrals custom-form | perinatal | |
| Haldimand Tongue Tie Assessment and Breastfeeding Support Clinic | Referrals | Midwifery | Telus PS |  | Download | 24 February 2025 | referrals custom-form | midwifery | |
| Halton-Niagara-Southern Ontario Sports and Exercise Medicine | Referrals | Sports Medicine | Telus PS |  | Download | 28 November 2024 | referrals custom-form | sports-medicine | |
| Hamilton Birth Control Clinic | Referrals | Telus PS |  | Download | 28 November 2024 | referrals custom-form | |||
| Hamilton General Hospital – Cardio Metabolic Centre of Excellence | Referrals | HGH | Telus PS |  | Download | 28 November 2024 | referrals custom-form | hgh | |
| Hamilton Health Sciences – Acquired Brain Injury Program | Referrals | Brain, HHS | Telus PS |  | Download | 28 November 2024 | referrals custom-form | brain hhs | |
| Hamilton Health Sciences – Breast MR Consult | Imaging | HHS | Telus PS |  | Download | 28 November 2024 | imaging custom-form | hhs | |
| Hamilton Health Sciences – Cancer Genetics Consultation | Referrals | Cancer Care, HHS | Telus PS |  | Download | 28 November 2024 | referrals custom-form | cancer-care hhs | |
| Hamilton Health Sciences – Cardiac/Coronary CT | Referrals | Cardiology, HHS | Telus PS |  | Download | 28 November 2024 | referrals custom-form | cardiology hhs | |
| Hamilton Health Sciences – Consent to Disclose Personal Health Information | Miscellaneous | HHS | Telus PS |  | Download | 13 February 2025 | miscellaneous custom-form | hhs | |
| Hamilton Health Sciences – McMaster – Valve Clinic | Referrals | HHS, McMaster | Telus PS |  | Download | 28 November 2024 | referrals custom-form | hhs mcmaster | |
| Hamilton Health Sciences – Medical Certificate of Disability | Miscellaneous | Disability, HHS | Telus PS |  | Download | 28 November 2024 | miscellaneous custom-form | disability hhs | |
| Hamilton Health Sciences – Medical Diagnostic Unit Requisition (MDU) | Imaging | HHS, MDU | Telus PS |  | Download | 28 November 2024 | imaging custom-form | hhs mdu | |
| Hamilton Health Sciences – Michael DeGroote Pain Management Program | Referrals | HHS, Pain | Telus PS |  | Download | 28 November 2024 | referrals custom-form | hhs pain | |
| Hamilton Health Sciences – MRI Consultation | Imaging | HHS, MRI | Telus PS |  | Download | 28 November 2024 | imaging custom-form | hhs mri | |
| Hamilton Health Sciences – MUMC – 2F Prenatal Diagnosis Clinic | Referrals | HHS, MUMC, Prenatal | Telus PS |  | Download | 13 February 2025 | referrals custom-form | hhs mumc prenatal | |
| Hamilton Health Sciences – MUMC – Adult Outpatient Swallowing Form | Referrals | HHS, MUMC | Telus PS |  | Download | 16 December 2024 | referrals custom-form | hhs mumc | |
| Hamilton Health Sciences – Nuclear Medicine Requisition | Imaging | HHS, Nuclear Medicine | Telus PS |  | Download | 28 November 2024 | imaging custom-form | hhs nuclear-medicine | |
| Hamilton Health Sciences – Nuclear Medicine Requisition – With Instructions | Imaging | HHS, Nuclear Medicine | Telus PS |  | Download | 28 November 2024 | imaging custom-form | hhs nuclear-medicine | |
| Hamilton Health Sciences – Request for CT Consultation | Imaging | CT, HHS | Telus PS |  | Download | 28 November 2024 | imaging custom-form | ct hhs | |
| Hamilton Health Sciences – Request for CT Consultation – With Instructions | Imaging | CT, HHS | Telus PS |  | Download | 28 November 2024 | imaging custom-form | ct hhs | |
| Hamilton Health Sciences – Special Immunology Services (SIS) Clinic – Adult Form | Referrals | HHS, Immunology | Telus PS |  | Download | 24 February 2025 | referrals custom-form | hhs immunology | |
| Hamilton Health Sciences – Special Immunology Services (SIS) Clinic – Pediatric Form | Referrals | HHS, Immunology, Pediatric | Telus PS |  | Download | 24 February 2025 | referrals custom-form | hhs immunology pediatric | |
| Hamilton Health Sciences – Voice Clinic | Referrals | HHS | Telus PS |  | Download | 28 November 2024 | referrals custom-form | hhs | |
| Hamilton Orthopaedic Institute – MSK Injury Clinic | Referrals | MSK, Orthopaedic | Telus PS |  | Download | 28 November 2024 | referrals custom-form | msk orthopaedic | |
| Hamilton Pain Clinic – Chronic Pain | Pain | Pain | Telus PS |  | Download | 28 November 2024 | pain custom-form | pain | |
| Hamilton Palliative Care Outreach Team Referral | Referrals | Palliative Care | Telus PS |  | Download | 28 November 2024 | referrals custom-form | palliative-care | |
| Hamilton Primary Care Skin Disorders Clinic | Referrals | Skin Disorders | Telus PS |  | Download | 28 November 2024 | referrals custom-form | skin-disorders | |
| Hamilton Vascular Laboratory | Imaging | Ultrasound | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | ultrasound | ||
| Health and Social Services – HNHSS – STI Reporting Form – Chlamydia-Gonorrhea | Referrals | Chlamydia, Gonorrhea, HNHSS, STI | Telus PS |  | Download | 24 February 2025 | referrals custom-form | chlamydia gonorrhea hnhss sti | |
| Health and Social Services – HNHSS – TB – Immigration Medical Surveillance | Referrals | HNHSS, TB | Telus PS |  | Download | 24 February 2025 | referrals custom-form | hnhss tb | |
| Heart and Health Clinic Requisition | Referrals | Cardiology | Telus PS |  | Download | 28 November 2024 | referrals custom-form | cardiology | |
| High Risk Ontario Breast Screening Program (OBSP) – Breast Cancer Genetic Assessment Results Form | Imaging | high risk screening, obsp | Telus PS |  | Download | 28 November 2024 | imaging custom-form | high-risk-screening obsp | |
| High Risk Ontario Breast Screening Program (OBSP) Requisition | Imaging | high risk screening, obsp | Telus PS |  | Download | 28 November 2024 | imaging custom-form | high-risk-screening obsp | |
| HNHB – Request for Ontario Health atHome Services | Referrals | HNHB, OHaH | Telus PS |  | Download | 28 November 2024 | referrals custom-form | hnhb ohah | |
| HNHB – Request for Ontario Health atHome Services – With Instructions | Referrals | HNHB, OHaH | Telus PS |  | Download | 28 November 2024 | referrals custom-form | hnhb ohah | |
| HNHB Behavioural Supports Ontario – Geriatric Services – Central Clinical Intake Referral | Referrals | BSO, CCI, Geriatric | Telus PS |  | Download | 28 November 2024 | referrals custom-form | bso cci geriatric | |
| HNHB Behavioural Supports Ontario – Geriatric Services – Central Clinical Intake Referral- With Instructions | Referrals | BSO, CCI, Geriatric | Telus PS | | Download | 28 November 2024 | referrals custom-form | bso cci geriatric | |
| HNHB Regional Aphasia Programs | Referrals | HNHB | Telus PS |  | Download | 28 November 2024 | referrals custom-form | hnhb | |
| HNHB Regional Cancer Program – Colonoscopy Referral | Referrals | Cancer Care, HNHB | Telus PS |  | Download | 28 November 2024 | referrals custom-form | cancer-care hnhb | |
| HNHBLHIN – MRI Req | Imaging | HNHB, MRI | Telus PS |  | Download | 28 November 2024 | imaging custom-form | hnhb mri | |
| HNHBLHIN – Palliative Symptom Response Order Form | Miscellaneous | HNHB, Palliative Care | Telus PS |  | Download | 28 November 2024 | miscellaneous custom-form | hnhb palliative-care | |
| JHCC-CIBC-BAC-Breast Referral Form | Referrals | HHS | Telus PS |  | Download | 28 November 2024 | referrals custom-form | hhs | |
| Joseph Brant Hospital – Ambulatory Care | Referrals | JBH | Ocean eReferral | Ocean Link | 28 November 2024 | referrals custom-form | jbh | ||
| Joseph Brant Hospital Child and Adolescent Psychiatry Clinic | Mental Health | JBH, Psychiatry | Ocean eReferral | Ocean Link | 28 November 2024 | mental-health custom-form | jbh psychiatry | ||
| Joseph Brant Hospital Diagnostic Imaging | Imaging | JBH | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | jbh | ||
| Joseph Brant Hospital Medical Diagnostic Unit | Imaging | JBH | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | jbh | ||
| Kitchener-Waterloo Vascular Laboratory | Imaging | Cardiology, Vascular | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | cardiology vascular | ||
| KMH Cardiology & MRI Centre – Markham | Imaging | Cardiology, KMH | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | cardiology kmh | ||
| KMH Cardiology & PET/CT Centre – Mississauga | Imaging | Cardiology, KMH | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | cardiology kmh | ||
| KMH Cardiology Centre – Burlington | Imaging | Cardiology, KMH | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | cardiology kmh | ||
| KMH Cardiology Centre – Hamilton | Imaging | Cardiology, KMH | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | cardiology kmh | ||
| KMH Cardiology Centre – North York | Imaging | Cardiology, KMH | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | cardiology kmh | ||
| KMH Cardiology Centre – Scarborough | Imaging | Cardiology, KMH | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | cardiology kmh | ||
| KMH Cardiology Centre – St. Catharines | Imaging | Cardiology, KMH | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | cardiology kmh | ||
| KMH Cardiology Centre – Toronto | Imaging | Cardiology, KMH | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | cardiology kmh | ||
| KMH Cardiology Centre – Woodstock | Imaging | Cardiology, KMH | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | cardiology kmh | ||
| Locke Medical Clinic – Consultation-EMG-NCS | Referrals | EMG, NCS | Telus PS |  | Download | 28 November 2024 | referrals custom-form | emg ncs | |
| m-Health Solutions Holter Monitoring | Imaging | ECG | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | ecg | ||
| Main Ultrasound | Imaging | Ultrasound | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | ultrasound | ||
| McMaster Children’s Hospital – Pediatric Adolescent Medicine Program | Referrals | McMaster, Pediatric | Telus PS |  | Download | 28 November 2024 | referrals custom-form | mcmaster pediatric | |
| McMaster Children’s Hospital – Pediatric Echocardiogram | Imaging | McMaster, Pediatric | Telus PS |  | Download | 13 February 2025 | imaging custom-form | mcmaster pediatric | |
| McMaster Children’s Hospital – Pediatric Respirology & Allergy | Referrals | Allergy, McMaster, Pediatric | Telus PS |  | Download | 28 November 2024 | referrals custom-form | allergy mcmaster pediatric | |
| McMaster Children’s Hospital – Pediatric Sleep Medicine | Referrals | McMaster, Pediatric, Sleep Medicine | Telus PS |  | Download | 28 November 2024 | referrals custom-form | mcmaster pediatric sleep-medicine | |
| McMaster Children’s Hospital – Psychiatry Consultation | Referrals | McMaster, Psychiatry | Telus PS |  | Download | 28 November 2024 | referrals custom-form | mcmaster psychiatry | |
| McMaster Children’s Hospital – MUMC – 2G Pediatric Ambulatory Clinics | Referrals | McMaster, Pediatric | Telus PS |  | Download | 13 February 2025 | referrals custom-form | mcmaster pediatric | |
| McMaster Spine Surgery – New Consult Requisition Form | Miscellaneous | McMaster | Telus PS |  | Download | 28 November 2024 | miscellaneous custom-form | mcmaster | |
| McMaster University – Central Triage Rheumatology | Referrals | McMaster, Rheumatology | Telus PS |  | Download | 26 February 2025 | referrals custom-form | mcmaster rheumatology | |
| Medical Assistance in Dying – MAiD – Clinician Aid C | Ministry of Health | MAiD, MOH | Telus PS |  | Download | 13 February 2025 | ministry-of-health custom-form | maid moh | |
| Medical Certificate for Employment Insurance Care Benefits | Miscellaneous | Telus PS |  | Download | 28 November 2024 | miscellaneous custom-form | |||
| Medisen Cardiology and Internal Medicine | Imaging | Cardiology, Internal Medicine | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | cardiology internal-medicine | ||
| MedSleep Niagara Falls | Referrals | Sleep Medicine | Ocean eReferral | Ocean Link | 28 November 2024 | referrals custom-form | sleep-medicine | ||
| Minerva Comprehensive Pain Management | Pain | Pain | Ocean eReferral | Ocean Link | 28 November 2024 | pain custom-form | pain | ||
| Ministry of Transportation – Medical Condition Report | Miscellaneous | MOT | Telus PS |  | Download | 13 February 2025 | miscellaneous custom-form | mot | |
| Misistry of Health – Patient Enrolment and Consent to Release Personal Health Information | Ministry of Health | Consent, MOH, PHI | Telus PS |  | Download | 28 November 2024 | ministry-of-health custom-form | consent moh phi | |
| Mount Sinai Hospital – Joint Department of Medical Imaging (JDMI) | Imaging | Bone, CT, Ultrasound | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | bone ct ultrasound | ||
| MUMC – 3F Pediatric Ambulatory Clinics | Referrals | Pediatric | Telus PS |  | Download | 28 November 2024 | referrals custom-form | pediatric | |
| Musculoskeletal – Central Intake & Assessment Centre – MSK CIAC – Low Back Pain Assessment | Referrals | MSK | Telus PS |  | Download | 13 February 2025 | referrals custom-form | msk | |
| NEJAC – Rapid Access Clinic | Referrals | Telus PS |  | Download | 28 November 2024 | referrals custom-form | |||
| Niagara Health Diagnostic Imaging | Imaging | Ultrasound, X-Ray | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | ultrasound x-ray | ||
| North Bay cardiology | Referrals | Cardiology | Telus PS |  | Download | 28 November 2024 | referrals custom-form | cardiology | |
| Oakville North Endoscopy | Referrals | Endoscopy | Telus PS |  | Download | 28 November 2024 | referrals custom-form | endoscopy | |
| One Vascular Requisition | Imaging | Vascular | Telus PS |  | Download | 28 November 2024 | imaging custom-form | vascular | |
| Ontario Breastfeeding Clinic (OBC) – Physician Group Referral | Referrals | OBC | Telus PS |  | Download | 28 November 2024 | referrals custom-form | obc | |
| Ontario Health – HPV – Cytology Test for Cervical Screening | Lab Requisitions, Ministry of Health | CCO, cytology, HPV, OH | Telus PS |  | Download | 19 February 2025 | lab-requisitions ministry-of-health custom-form | cco cytology hpv oh | |
| Ontario Health – HPV – Cytology Test for Cervical Screening – OSCAR | Lab Requisitions, Ministry of Health | CCO, HPV, OH | OSCAR | | Download | 19 February 2025 | lab-requisitions ministry-of-health custom-form | cco hpv oh | |
| Ontario Health – Lung Screening Program | Referrals | Lung, OH | Telus PS |  | Download | 28 November 2024 | referrals custom-form | lung oh | |
| Ontario Health – Lung Screening Program – With Instructions | Referrals | Lung, OH | Telus PS |  | Download | 28 November 2024 | referrals custom-form | lung oh | |
| Ontario Health – HPV – Cytology Test – Colposcopy follow-up of Cervical Screening | Lab Requisitions, Ministry of Health | CCO, Colposcopy, cytology, HPV, OH | Telus PS |  | Download | 26 February 2025 | lab-requisitions ministry-of-health custom-form | cco colposcopy cytology hpv oh | |
| Ontario Health – Lung Screening Program – SJH | Referrals | Lung, OH | Telus PS |  | Download | 16 December 2024 | referrals custom-form | lung oh | |
| Ontario Health – Lung Screening Program – SJH – With Instructions | Referrals | Lung, OH | Telus PS | | Download | 16 December 2024 | referrals custom-form | lung oh | |
| Ontario Health atHome – HNHB First Dose IV Risk Assesment | Referrals | OHaH | Telus PS |  | Download | 28 November 2024 | referrals custom-form | ohah | |
| Ontario Health atHome – HNHB Iron Infusion Order Form | Referrals | OHaH | Telus PS |  | Download | 28 November 2024 | referrals custom-form | ohah | |
| Ontario Health atHome – HNHB Iron Infusion Order Form – With Instructions | Referrals | OHaH | Telus PS |  | Download | 28 November 2024 | referrals custom-form | ohah | |
| Ontario Health atHome – Letter of Understanding for the Pronouncement of Death | Miscellaneous | OH | Telus PS |  | Download | 13 February 2025 | miscellaneous custom-form | oh | |
| Ontario Health atHome – SouthWest – Request for Assessment | Referrals | OHaH | Telus PS |  | Download | 24 February 2025 | referrals custom-form | ohah | |
| Ontario Health atHome Waterloo Wellington | Referrals | OHaH | Ocean eReferral | Ocean Link | 28 November 2024 | referrals custom-form | ohah | ||
| Ontario Structured Psychotherapy West | Mental Health | OSPW | Ocean eReferral | Ocean Link | 28 November 2024 | mental-health custom-form | ospw | ||
| Organon Aspire – NEXPLANON – Scheduling Support Appointment Form | Miscellaneous | NEXPLANON | Telus PS |  | Download | 16 December 2024 | miscellaneous custom-form | nexplanon | |
| Pain Care Clinic – Hamilton | Pain | Pain, PCC | Ocean eReferral | Ocean Link | 28 November 2024 | pain custom-form | pain pcc | ||
| Pain Care Clinic – Kitchener | Pain | Pain, PCC | Ocean eReferral | Ocean Link | 28 November 2024 | pain custom-form | pain pcc | ||
| Pain Care Clinic – Mississauga | Pain | Pain, PCC | Ocean eReferral | Ocean Link | 28 November 2024 | pain custom-form | pain pcc | ||
| Pain Care Clinic – Niagara Falls | Pain | Pain, PCC | Ocean eReferral | Ocean Link | 28 November 2024 | pain custom-form | pain pcc | ||
| Pain Care Clinic – Orangeville | Pain | Pain, PCC | Ocean eReferral | Ocean Link | 28 November 2024 | pain custom-form | pain pcc | ||
| Pain Care Clinic – St. Catherines | Pain | Pain, PCC | Ocean eReferral | Ocean Link | 28 November 2024 | pain custom-form | pain pcc | ||
| Pain Care Clinic – Welland | Pain | Pain, PCC | Ocean eReferral | Ocean Link | 28 November 2024 | pain custom-form | pain pcc | ||
| Pain Care Clinic – Windsor | Pain | Pain, PCC | Ocean eReferral | Ocean Link | 28 November 2024 | pain custom-form | pain pcc | ||
| Pain Care Clinic – Windsor County | Pain | Pain, PCC | Ocean eReferral | Ocean Link | 28 November 2024 | pain custom-form | pain pcc | ||
| Possibilities Clinic | Referrals | ADHD, Mental Health | Ocean eReferral | Ocean Link | 28 November 2024 | referrals custom-form | adhd mental-health | ||
| Precision Care Centre | Imaging | Pain, Radiology | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | pain radiology | ||
| Provis Endoscopy Services – Ottawa East | Referrals | Endoscopy | Ocean eReferral | Ocean Link | 28 November 2024 | referrals custom-form | endoscopy | ||
| Public Health Ontario – General Test Requisition | Lab Requisitions | PHO, public health | Telus PS |  | Download | 28 November 2024 | lab-requisitions custom-form | pho public-health | |
| Public Health Ontario – General Test Requisition – With Instructions | Lab Requisitions | PHO, public health | Telus PS |  | Download | 28 November 2024 | lab-requisitions custom-form | pho public-health | |
| Public Health Ontario – HCV/HBV Viral Load, Genotyping, and Drug Resistance | Lab Requisitions | PHO, public health | Telus PS |  | Download | 13 February 2025 | lab-requisitions custom-form | pho public-health | |
| Public Health Ontario – HCV/HBV Viral Load, Genotyping, and Drug Resistance – With Instructions | Lab Requisitions | PHO, public health | Telus PS | | Download | 13 February 2025 | lab-requisitions custom-form | pho public-health | |
| Public Health Ontario – Reference Bacteriology Requisition | Lab Requisitions | bacteriology, PHO, public health | Telus PS |  | Download | 28 November 2024 | lab-requisitions custom-form | bacteriology pho public-health | |
| Public Health Ontario – Report of Adverse Event Following Immunization – 2024 | Miscellaneous | PHO, public health | Telus PS |  | Download | 28 November 2024 | miscellaneous custom-form | pho public-health | |
| Public Health Services Hamilton – Chlamydia Surveillance Package CICW | Lab Requisitions | Chlamydia, PHO, public health | Telus PS |  | Download | 28 November 2024 | lab-requisitions custom-form | chlamydia pho public-health | |
| Public Health Services Hamilton – Gonorrhea Surveillance Package CICW | Lab Requisitions | Gonorrhea, PHO, public health | Telus PS |  | Download | 28 November 2024 | lab-requisitions custom-form | gonorrhea pho public-health | |
| Public Health Services Hamilton – Positive TB Skin Test (TST) | Lab Requisitions | Skin, TB | Telus PS |  | Download | 28 November 2024 | lab-requisitions custom-form | skin tb | |
| Public Health Services Hamilton – RSV Vaccine Order Form | Miscellaneous | public health, Vaccine | Telus PS |  | Download | 13 February 2025 | miscellaneous custom-form | public-health vaccine | |
| Rejuvenation Dermatology Oakville – RapidDerm Clinic | Referrals | Dermatology | Telus PS |  | Download | 13 February 2025 | referrals custom-form | dermatology | |
| Request for Boehringer Ingelheim – Medication Form | Miscellaneous | Medication | Telus PS |  | Download | 28 November 2024 | miscellaneous custom-form | medication | |
| Restore Hyperbaric Oxygen and Medical Centre | Referrals | Oxygen | Ocean eReferral | Ocean Link | 28 November 2024 | referrals custom-form | oxygen | ||
| SJH – FIRH – Firestone Institute for Respiratory Health – Laboratory Requisition | Lab Requisitions | firestone, FIRH, SJH | Telus PS |  | Download | 27 March 2025 | lab-requisitions custom-form | firestone firh sjh | |
| South Coast Physiotherapy | Referrals | Physiotherapy | Telus PS |  | Download | 13 February 2025 | referrals custom-form | physiotherapy | |
| Southwest Ultrasound | Imaging | Ultrasound | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | ultrasound | ||
| St. Joseph’s Healthcare Hamilton – Cardiology Diagnostics | Imaging | Cardiology, SJH | Telus PS |  | Download | 27 March 2025 | imaging custom-form | cardiology sjh | |
| St. Joseph’s Healthcare Hamilton – Connect Mental Health and Addiction Outpatient Programs | Mental Health | addiction, Mental Health, SJHH | Ocean eReferral | Ocean Link | 28 November 2024 | mental-health custom-form | addiction mental-health sjhh | ||
| St. Joseph’s Healthcare Hamilton – Diagnostic Imaging – Charlton Campus | Imaging | SJHH | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | sjhh | ||
| St. Joseph’s Healthcare Hamilton – Diagnostic Imaging – King Campus | Imaging | SJHH | Ocean eReferral | Ocean Link | 16 December 2024 | imaging custom-form | sjhh | ||
| St. Joseph’s Healthcare Hamilton – Diagnostic Imaging – West 5th Campus | Imaging | SJHH | Ocean eReferral | Ocean Link | 16 December 2024 | imaging custom-form | sjhh | ||
| St. Joseph’s Healthcare Hamilton – Esophageal Diagnostic Assessment Program | Referrals | SJHH | Ocean eReferral | Ocean Link | 28 November 2024 | referrals custom-form | sjhh | ||
| St. Joseph’s Healthcare Hamilton – IV Iron Replacement Order Set | Miscellaneous | IV Iron, SJH | Telus PS |  | Download | 28 November 2024 | miscellaneous custom-form | iv-iron sjh | |
| St. Joseph’s Healthcare Hamilton – Obstetrics & Gynecology 2 Fontbonne | Referrals | Gynecology, Obstetrics, SJHH | Ocean eReferral | Ocean Link | 28 November 2024 | referrals custom-form | gynecology obstetrics sjhh | ||
| St. Joseph’s Healthcare Hamilton – Outpatient Nephrology | Referrals | Nephrology, SJHH | Ocean eReferral | Ocean Link | 28 November 2024 | referrals custom-form | nephrology sjhh | ||
| St. Joseph’s Healthcare London – ROTH McFarlane Hand and Upper Limb Centre | Referrals | SJH | Telus PS |  | Download | 28 November 2024 | referrals custom-form | sjh | |
| St. Peter’s Hospital – Centre for Healthy Aging – Long Term Care Home | Referrals | HHS | Telus PS |  | Download | 13 February 2025 | referrals custom-form | hhs | |
| SUGO – Specialized Ultrasound in Gynecology & Obstetrics | Imaging | Gynecology, Obstetrics, Ultrasound | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | gynecology obstetrics ultrasound | ||
| The Minor Surgery Center | Referrals | TMSC | Telus PS |  | Download | 28 November 2024 | referrals custom-form | tmsc | |
| UHN – Centre for Mental Health | Referrals | Mental Health | Telus PS |  | Download | 28 November 2024 | referrals custom-form | mental-health | |
| UltraScan Medical Diagnostic Imaging | Imaging | Ultrasound | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | ultrasound | ||
| WELL Health Diagnostic Centres – Brantford – Cardiology | Imaging | Cardiology | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | cardiology | ||
| WELL Health Diagnostic Centres – Mississauga – Cardiology | Imaging | Cardiology | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | cardiology | ||
| Wentworth-Halton X-Ray and Ultrasound Inc. – 15 Mountain Ave | Imaging | Ultrasound, WH, X-Ray | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | ultrasound wh x-ray | ||
| Wentworth-Halton X-Ray and Ultrasound Inc. – 325 Winterberry Drive | Imaging | Ultrasound, WH, X-Ray | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | ultrasound wh x-ray | ||
| Wentworth-Halton X-Ray and Ultrasound Inc. – Medical Arts | Imaging | Ultrasound, WH, X-Ray | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | ultrasound wh x-ray | ||
| Wentworth-Halton X-Ray and Ultrasound Inc. – Waterdown | Imaging | Ultrasound, WH, X-Ray | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | ultrasound wh x-ray | ||
| Wentworth-Halton X-Ray and Ultrasound Inc. – Westmount | Imaging | Ultrasound, WH, X-Ray | Ocean eReferral | Ocean Link | 28 November 2024 | imaging custom-form | ultrasound wh x-ray | ||
| West Lincoln Memorial Hospital – Breast Imaging Requisition | Referrals | WLMH | Telus PS |  | Download | 24 February 2025 | referrals custom-form | wlmh | |
| Women’s College Hospital – Mental Health | Referrals | Mental Health, WCH | Telus PS |  | Download | 28 November 2024 | referrals custom-form | mental-health wch |
Custom Form Archive (Older Forms)
| Form | Form Categories | Subject | EMR | 1st Page Preview | Form Location | Link | Date Modified |
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