SIMPLEOSF nonprofit is currently working with Ontario government eHealth authorities and other relevant parties to convert all the frequently used referral forms for outpatient hospital/government services and other 3rd party services in the province into eForms for greater efficiency and accessibility of care.
We ask physicians in the province for input on which forms are most used, to prioritize their development. Please add your suggestions below; you can also upvote others’. Please specify a link to the form you’re suggesting, in the description field.
eForm Requests
- 64WSIB Form 8WSIB Form 8 initial report
- 61WSIB FAFWSIB Functional Abilities Form
- 52IPS Form North York General Prenatal Screening RequisitionPrenatal Screening Req
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- 48MRI Requisition SouthWest OntarioChoosing Wisely Canada MRI Req for SW LHIN
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- 45MRI Knee Appropriateness Checklist SouthWest LHINChoosing Wisely Canada MRI Knee Appropriateness Checklist SWLHIN
- 41Orthopaedic Consult Hip and Knee Arthritis Program SouthWest Musculoskeletal Rapid Access ClinicReferral to SouthWest MSK RAC
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- 38Adult Mental Health Ambulatory Centralized Access Point Referral - LHSC and SJHfor LHSC and St. Joseph's London Ontario
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- 34Prenatal Screening Requisition Public Health OntarioRequisition for Prenatal Screening tests: https://www.publichealthontario.ca/-/media/Documents/Lab/prenatal-screening.pdf
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- 34MRI Spine ChecklistChoosing Wisely Canada - SouthWest LHIN MRI Referral Spine Appropriateness Checklist
- 34Morcare Insurance Claim FormInternation student Morcare insurance claim form
- 33HIV Serology Test Requisition Public Health OntarioThe requisition for HIV serology/HIV PCR lab tests: https://www.publichealthontario.ca/-/media/Documents/Lab/hiv-serology.pdf
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- 32KMH Cardiology and Imaging Referral FormsKMH Cardiology and Imaging
- 31LHSC Ultrasound RequisitionLHSC Ultrasound
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- 31Immunizations Receipt eFormeForm used to provide patient with receipt of their immunization
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- 31MyHealth Centre Requisition Southwestern OntarioMyHealth Centre
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- 29London Scoping Centre ReferralReferral to LSC
- 29LHSC Children's Ultrasound, Fluoroscopy and General X-Ray RequisitionLHSC Children's Hospital (Victoria Hospital)
- 28General Test Requisition Public Health OntarioThe requisition for general public health lab tests: https://www.publichealthontario.ca/-/media/Documents/Lab/general-test-requisition.pdf
- 28LHSC SJH Asthma CenterAsthma Center referral
- 28London Cardiac Institute ReferralLondon Cardiac Institute
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- 27InMedic Pain Clinic ReferralPain Clinic Referral
- 27MyHealth Centre Pain Injections Requisition LondonMyHealth Centre
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- 26Bluewater Sleep Disorder Clinic ReferralBWSDC Referral
- 26LHSC Hematology ReferralHematology Referral LHSC
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- 24Peak Sleep Study RequisitionRequisition
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- 23SJH LHSC Audiology ReferralAudiology
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- 23Cardio Study ReferralCardiology
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- 22Botox Cosmetic Procedure NoteBotox / Onabotulinumtoxina
- 21Prostate DAP Referral LHSC SJHSt. Joseph's Hospital London Prostate DAP Referral
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- 21LHSC VH Paediatric Neurology Consult ReferralVictoria Hospital LHSC
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- 21UHIP Claim FormInternational student UHIP insurance claim form
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- 20Team Care East London Referral (LHIC)London Intercommunity Health Centre (LIHC)
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- 19SJH Radiology Referral FormSt. Joseph's Hospital London
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- 19Dr. Lacerte PM&R Partial Assessment & Procedure RequestPM&R Partial Assessment & Procedures Request Dr. Michel Lacerte
- 18LHSC EEG Requisition UHUniversity Hospital EEG Requisition LHSC London
- 18LHSC London Regional Cancer Program Referral (LRCP)LRCP Referral
- 18Colposcopy Clinic Referral LHSC SJHSt. Joseph's Hospital London LHSC Colposcopy Clinic Referral
- 18LHSC Cancer Genetics ReferralLHSC Cancer Genetics Clinic Referral
- 18SJH Cardiovascular Investigation Unit ReferralSJH Cardiovascular Investigation Unit Referral
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- 18Umbilical Inguinal Hernias and Gallbladder Disease Referral LHSCDivision of General Surgery
- 18Sleep and Apnea Assessment Unit LHSC ReferralSleep and Apnea Assessment Referral
- 17LHSC Plastic Surgery Clinic Skin Cancer ReferralLHSC Plastic Surgery Clinic Skin Cancer Referral
- 17SJH LHSC Regional Acquired Brain Injury Outpatient Services Physiatry ReferralSJH LHSC Regional Acquired Brain Injury Outpatient Services Physiatry Referral
- 16Neurotology Clinic Referral University Hospital LHSCReferral to Neurotology Clinic London Ontario UH LHSC
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- 15The Spine Centre LHSC Surgical ReferralSpine Centre
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- 15MyHealth Centre Interventional Procedures RequisitionMyHealth Centre
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- 14LHSC Medical Genetics ReferralLHSC Medical Genetics Program Referral
- 14Urgent Cardiology Clinic Citi Plaza London ReferralCiti Plaza London
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- 12DermCafe Dermatology ReferralVirtual-only dermatology clinic, requesting update to their referral form to improve functionality and format
- 11St. Thomas Elgin General Hospital Diagnostic Imaging Requisition - Xray, CT, Mammography, OBSP, BMDXray, CT, Mammography, OBSP, BMD
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- 10Sleep Apnea QuestionnairesSleep Apnea Questionnaire eForm
- 9Viral Prescription Pad eFormViral Rx
- 7Framingham CalculatorFramingham Calculator eForm