Fraser Health Authority Paediatric Diabetes Referral Form

ADVERTISEMENT

FRASER HEALTH PAEDIATRIC DIABETES
REFERRAL PROCESS AND FORM
DOCTORS IN THE COMMUNITY:
SUSPECTED TYPE 1 Pediatric patient in the community: the patient and family should be sent to
emergency to be stabilized and will either need to be admitted for inpatient teaching at SMH, RCH or
ARH or stabilized and referred for outpatient teaching at BC Children’s hospital.
NEW DX T1D
RCH-ER
SMH-ER
ARH-ER
BCCH-ER
INPATIENT
INPATIENT
INPATIENT
INPATIENT OR
TEACHING
TEACHING
TEACHING
OUTPATIENT
TEACHING
***ONCE INITIAL TEACHING IS DONE A REFERAL CAN BE SENT FOR ONGOING
OUTPATIENT CLINIC FOLLOW UP AT ONE OF THE LOCATIONS BELOW***
ERH
SMH
ARH
BCCH
Ongoing
Ongoing
Ongoing
Ongoing
Follow Up
Follow Up
Follow Up
Follow Up
SUSPECTED TYPE 2 Pediatric patient in the community: the patient should be stabilized and referred
to one of the pediatric diabetes centers. For those individuals requiring insulin, inpatient teaching or
teaching via BCCH’s Outpatient day program would be required.
ESTABLISHED TYPE 1 OR TYPE 2: a referral form (see page 2) should be sent with all the recent
labs, growth chart and visits to the appropriate diabetes center. ***If the patient has been seen at BC
Children’s they will need to inform their Endocrinologist and cancel any existing appointments.***
PLEASE MAIL OR FAX COMPLETED FORM TO THE APPROPRIATE CENTER
SMH Pediatric Diabetes Clinic
Phone: 604-587-3929
Charles Barham Pavilion, Surrey Memorial Hospital
Fax:
604-585-5968
th
13750 96
Ave, Surrey BC, V3V 1Z2
ARH Pediatric Diabetes Clinic
Phone: 604- 851-4700
Pediatric Diabetes Clinic
Ext. 646267
32900 Marshall Rd, Abbotsford, BC V2S 0C2
Fax:
604- 851-4790
Tri Cities Diabetes Health Centre
Phone: 604- 949-7771
475 Guildford Way, Port Moody, BC V3H 3W9
Fax:
604- 949-7772

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Diabetes Management And Treatment Plan Physician/parent Authorization For Diabetes Care Form - North East Independent School District Diabetes Management And Treatment Plan Physician/parent Authorization For Diabetes Care Form - North East Independent School District Business
Health Net Dental Specialist Referral Form Health Net Dental Specialist Referral Form Medical
Mental Health Services And Support Referral Form Mental Health Services And Support Referral Form Medical
Behavioral Health / Medical Care Coordination Referral Form Behavioral Health / Medical Care Coordination Referral Form Business
Adult Outpatient Mental Health Services Coordinated Intake Referral Form Adult Outpatient Mental Health Services Coordinated Intake Referral Form Medical
Form Ef03-14040 - Provider Outreach Referral Form Form Ef03-14040 - Provider Outreach Referral Form Legal
Paediatric Neurology Regional Tertiary Headache Clinic Referral Form Paediatric Neurology Regional Tertiary Headache Clinic Referral Form Medical
Diabetes Self Management Program Referral Form Diabetes Self Management Program Referral Form Medical
Referral Form - Ck Behavioral Health Referral Form - Ck Behavioral Health Medical
Health Advantage Specialty Referral Form Health Advantage Specialty Referral Form Business

Related Categories

Parent category: Medical
Download
Go
Page of 2