Cardiac Catheterization & Percutaneous Coronary Intervention (PCI) Referral Forms
CorHealth is no longer hosting branded referral forms on our website for each facility.
CorHealth will host referral form templates on the Support page within the DCIS that can be branded and customized by each facility. The forms have been updated to reflect the CorHealth Data Collection & Information System (DCIS) dataset. This form is not appropriate for use as a referral for procedure.
Below is a list of the primary telephone and fax numbers for each facility’s coronary angiogram referral triage program. To obtain the most up-to-date version of a referral form contact that facility directly.
Please transmit the completed referral form via fax to the Regional Cardiac Care Coordinator at the facility you wish to refer to.
Please Note: Do not send any referral forms or PHI of any kind to Ontario Health – CorHealth Ontario. Please, fax it directly to one of the designated contacts at a cardiac facility.
| FACILITY | PHONE | FAX NUMBER |
|---|---|---|
| Hamilton Health Science | 905-521–2100 ext. 46674 | 905-527-2691 |
| Health Sciences North | 705-523-7100 ext. 5550 | 705-523-7102 |
| Kingston Health Sciences Centre | 613-548-1399 ext. 2 | 613-548-2407 |
| London Health Sciences Centre | 519-663-3069 | |
| Michael Garron Hospital | 416-469-6443 | |
| Niagara Health Systems | 905-521–2100 ext. 46674 | 905-527-2691 |
| Peterborough Regional Health Centre | 705-743-2121 ext. 3258 | 705-876-5155 |
| Rouge Valley Health System | 416-281-3156 or 416-281-7274 | |
| Royal Victoria Regional Health Centre | 705-728-9802 ext. 46123 | 705-797-3077 or 905-830-5802 |
| Sault Area Hospital | Cardiac Care Coordinator: 705-759-3434 ext. 6994 Cath Lab: 705-759-3434 ext. 5811 |
705-256-3491 |
| Scarbrough Health Network | 416-284-8131 ext. 5326 Cardiac Care Coordinator: 416-281-7477 |
416-284-3156 |
| Southlake Regional Health Centre | 905-895-4521 ext. 2707 | |
| St. Mary’s General Hospital | 519-749-6541 | 519-749-6606 |
| Sunnybrook Health Sciences Centre | 416-480-6100 ext. 7160 or 3234 | 416-480-5892 |
| Thunder Bay Regional Health Science Centre | 807-684-6675 | 807-684-5902 |
| Trillium Health Partners | 905-848-7396 | 905-848-7358 |
| University of Ottawa Heart Institute | Cardiology Coordinator: 613-696-7061 (inpatients) 613-696-7064 (outpatients) |
613-696-7144 |
| Unity Health Toronto | 416-864-5455 | |
| University Health Network | 416-340-3788 | |
| William Osler Health Centre | 905-494-2120 ext. 58525 | 905-494-0280 |
| Windsor Regional Health Centre | RCCC/Cath Lab Coordinator: 519-973-4444 ext. 33156 | 519-973-5584 |