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. Read more about the effort here: Simple Open Source Fund Inc. – Solution to the Healthcare Paperwork Crisis (simpleosf.org)
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
- 49
- 48MRI Requisition SouthWest OntarioChoosing Wisely Canada MRI Req for SW LHIN
- 47
- 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
- 40
- 38Adult Mental Health Ambulatory Centralized Access Point Referral - LHSC and SJHfor LHSC and St. Joseph's London Ontario
- 36
- 35
- 34Prenatal Screening Requisition Public Health OntarioRequisition for Prenatal Screening tests: https://www.publichealthontario.ca/-/media/Documents/Lab/prenatal-screening.pdf
- 34
- 34
- 34
- 34
- 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
- 32
- 32KMH Cardiology and Imaging Referral FormsKMH Cardiology and Imaging
- 31LHSC Ultrasound RequisitionLHSC Ultrasound
- 31
- 31Immunizations Receipt eFormeForm used to provide patient with receipt of their immunization
- 31
- 31MyHealth Centre Requisition Southwestern OntarioMyHealth Centre
- 31
- 30
- 30
- 30
- 30
- 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
- 28
- 27InMedic Pain Clinic ReferralPain Clinic Referral
- 27MyHealth Centre Pain Injections Requisition LondonMyHealth Centre
- 27
- 26Bluewater Sleep Disorder Clinic ReferralBWSDC Referral
- 26LHSC Hematology ReferralHematology Referral LHSC
- 26
- 25
- 25
- 24
- 24Peak Sleep Study RequisitionRequisition
- 24
- 23SJH LHSC Audiology ReferralAudiology
- 23
- 23Cardio Study ReferralCardiology
- 23
- 22
- 22Botox Cosmetic Procedure NoteBotox / Onabotulinumtoxina
- 21Prostate DAP Referral LHSC SJHSt. Joseph's Hospital London Prostate DAP Referral
- 21
- 21LHSC VH Paediatric Neurology Consult ReferralVictoria Hospital LHSC
- 21
- 21UHIP Claim FormInternational student UHIP insurance claim form
- 20
- 20Team Care East London Referral (LHIC)London Intercommunity Health Centre (LIHC)
- 19
- 19SJH Radiology Referral FormSt. Joseph's Hospital London
- 19
- 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
- 18
- 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
- 15
- 15The Spine Centre LHSC Surgical ReferralSpine Centre
- 15
- 15
- 15MyHealth Centre Interventional Procedures RequisitionMyHealth Centre
- 14
- 14
- 14LHSC Medical Genetics ReferralLHSC Medical Genetics Program Referral
- 14Urgent Cardiology Clinic Citi Plaza London ReferralCiti Plaza London
- 14
- 14
- 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
- 11
- 10Sleep Apnea QuestionnairesSleep Apnea Questionnaire eForm
- 9Viral Prescription Pad eFormViral Rx
- 7Framingham CalculatorFramingham Calculator eForm