Cardiac Catheterization & Percutaneous Coronary Intervention (PCI) Referral Forms

Provincial Cath Referral Forms for Adult Patients

Please note:

Fax completed cath-referral form to the Regional Cardiac Care Coordinator.
Do not fax the cath-referral form to the Provincial Office but directly to one of the contacts at a cardiac centre.
This form is for use by referring physicians only; referrals for cath cannot be made by patients or other non-physicians.
Written approval following the accountability framework is required before any arrangements are made.
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 - PLEASE FAX ALL FORMS TO REFERRAL HOSPITAL - DO NOT FAX TO CORHEALTH ONTARIO

Submission Instructions

CCN Referral Form Code Definitions

HHS Cath Referral Form

HSN Cath Referral Form

KGH Cath Referral Form

LHSC Cath Referral Form

MGH Cath Referral Form

NHS Cath Referral Form

PRHC Cath Referral Form

RVH Cath Referral Form

RVHS Cath Referral Form

SAH Cath Referral Form

SHSC Cath Referral Form

SMGH Cath Referral Form

SMH Cath Referral Form

SRHC Cath Referral Form

TBRHSC Cath Referral Form

THP Cath Referral Form

UHN Cath Referral Form

UOHI Cath Referral Form

WOHS Cath Referral Form

WRH Cath Referral Form