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
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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
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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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