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
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- 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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- 31Immunizations Receipt eFormeForm used to provide patient with receipt of their immunization
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- 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
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- 21Prostate DAP Referral LHSC SJHSt. Joseph's Hospital London Prostate DAP Referral
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- 20Team Care East London Referral (LHIC)London Intercommunity Health Centre (LIHC)
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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
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- 18Colposcopy Clinic Referral LHSC SJHSt. Joseph's Hospital London LHSC Colposcopy Clinic Referral
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- 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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- 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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