EMR Resources

Welcome to the South West Digital Coalition’s Forms Repository. Our aim is to provide Accuro and PS Suite EMR users in the South West an up-to-date library of common referral and requisition forms that meet a minimum standard of quality and functionality.

The Coalition has drafted Requisition and Referral Form Design Recommendations for stakeholders across the region who develop forms for use by primary care providers.

The Digital Coalition was officially launched on November 27th, 2018. For more information regarding this initiative please contact info@partneringforquality.ca.

**click here to access the South West LHIN MRI Launch Training Videos **

See All Resources

Location

Organization

Form Type

Data	location	org	region
Arthritis Society Referral Form Accuro (see "How to Import Forms" in the DC Toolkit)- Form: Arthritis Society - Referral - DC; Publisher: pdalton Posted Dec 14, 2018 by Partnering for Quality - Digital Coalition Arthritis Society - Referral - DC.pdf Arthritis_Society_Referral_Form_March_2018.cfm	,0,1,2,3,4,5,	,0,63,	,0,1,3,
Canadian Mental Health Association Bounce Back Referral Form (Update Jan 2020) Accuro (see "How to Import Forms" in the DC Toolkit); Form: CMHA - BounceBack Program Referral- DC; Publisher: pdalton Posted Dec 14, 2018 by Partnering for Quality - Digital Coalition CMHA - BounceBack Program Referral - DC.cfm CMHA-Bounceback Program Referral update-DC.pdf	,0,1,2,3,4,5,6,7,8,	,0,19,20,21,22,23,	,0,3,1,
CMHA Elgin Intake Referral Form Currently not available for Accuro. Please contact info@partneringforquality.ca for more information. Posted Nov 22, 2018 by Partnering for Quality - Digital Coalition CMHA Elgin - Intake Referral - DC.pdf CMHA Intake Referral Form 2016.cfm	,0,3,	,0,19,	,0,1,3,
Elgin VON Intake Referral Form Currently not available for Accuro and PDF. Please contact info@partneringforquality.ca for more information. Posted Mar 26, 2019 by info@partneringforquality.ca Elgin - Community Support Services (VON Central Intake) Referral - DC.cfm	,0,3,	,0,100,	,0,3,
HPHA Nuclear Medicine/BMD Requisiton Accuro (see "How to Import Forms" in the DC Toolkit); Form: Huron-Perth Healthcare Alliance - Nuclear Medicine/BMD - DC ; Publisher: wejerrett Posted Nov 14, 2018 by ian.hicks HPHA - Nuclear Medicine_BMD- DC.pdf HPHA - Nuclear Medicine_BMD - DC.cfm	,0,4,	,0,106,	,0,1,3,
HPHA Xray/Ultrasound/BMD Requisition Accuro (see "How to Import Forms" in the DC Toolkit); Form: Huron-Perth Healthcare Alliance - Xray/Ultrasound/BMD Requisition - DC ; Publisher: wejerrett Posted Nov 14, 2018 by ian.hicks HPHA - Xray_Ultrasound_BMD Requisition - DC.pdf HPHA - Xray_Ultrasound_BMD Requisition - DC.cfm	,0,4,	,0,106,	,0,1,3,
HPHA Breast Imaging Consultation Requisition Accuro (see "How to Import Forms" in the DC Toolkit); Form: Huron-Perth Healthcare Alliance - Breast Imaging Consultation - DC ; Publisher: wejerrett Posted Nov 14, 2018 by ian.hicks HPHA - Breast Imaging Consultation - DC.pdf HPHA - Breast Imaging Consultation - DC.cfm	,0,4,	,0,106,	,0,1,3,
Kidney Wise Outpatient Nephrology Referral Currently not available for Accuro and PDF. Please contact info@partneringforquality.ca for more information. Posted Dec 14, 2018 by sarah.recinos ORN - KidneyWise Outpatient Nephrology Referral Form - DC.cfm	,0,1,2,3,4,5,	,0,63,	,0,3,
Kidney Wise Outpatient Nephrology Referral Lab Requisition Currently not available for Accuro and PDF. Please contact info@partneringforquality.ca for more information. Posted Nov 22, 2018 by ian.hicks KidneyWise_Nephrology_Labs.cfm	,0,1,2,3,4,5,	,0,63,	,0,3,
LHSC / SJHC London Ultrasound Requisition Accuro (see "How to Import Forms" in the DC Toolkit); Form: London Health Sciences Centre - St. Joseph's Health Care, London - Ultrasound Requisition - DC ; Publisher: tcarter Posted Feb 10, 2019 by candice.beselaere LHSC SJHC - US Requisition.pdf LHSC - SJHC - Ultrasound Requisition - DC.cfm	,0,1,	,0,51,82,	,0,1,3,
London Pediatric Sleep Clinic - Referral Currently not available for Accuro. Please contact info@partneringforquality.ca for more information. Posted Nov 22, 2018 by ian.hicks London Pediatric Sleep Clinic - Referral - DC.pdf London_Pediatric_Sleep Clinic.cfm	,0,1,	,0,63,	,0,1,3,
London Specialists Group (Medpoint) Referral Currently not available for Accuro. Please contact info@partneringforquality.ca for more information. Posted Mar 26, 2019 by info@partneringforquality.ca London Specialists Group (Medpoint) Referral - DC.cfm London Specialists Group (Medpoint) Referral - DC.pdf	,0,1,	,0,63,	,0,3,1,
LRCP - Multidisciplinary Skin Carcinoma Clinic Referral Currently not available for Accuro. Please contact info@partneringforquality.ca for more information. Posted Nov 22, 2018 by ian.hicks LRCP - Multidisciplinary Skin Carcinoma Clinic Referral - DC.pdf LRCP_Multidisciplinary_Skin_Carcinoma_Clinic_Referral_Form_2018.cfm	,0,1,2,3,4,5,	,0,51,	,0,1,3,
Ministry of Transportation Medical Condition Report - unfit to drive Currently not available for Accuro. Please contact info@partneringforquality.ca for more information. Posted Nov 22, 2018 by ian.hicks MTO - Medical Condition Unfit to Drive Report - DC.pdf MTO - Medical Condition Unfit to Drive Report - DC.cfm	,0,1,2,3,4,5,	,0,62,	,0,1,3,
South West LHIN - Health Links CCP Referral Form Accuro (see "How to Import Forms" in the DC Toolkit); Form: Health Links-Coordinated Care Plan CCP long form-July 2018-DC ; Publisher: wejerrett Posted Apr 16, 2019 by candice.beselaere Health Links CCP Long Form July 2018.cfm South West LHIN - Coordinated Care Plan.pdf	,0,1,2,3,4,5,	,0,76,	,0,3,1,
South West LHIN - Health Links Registration/Update/Discharge Form Accuro (see "How to Import Forms" in the DC Toolkit); Form: Health Links CCP Registration Update Discharge ; Publisher: wejerrett . PDF Currently not available, contact info@partneringforquality.ca for more information. Posted Apr 16, 2019 by candice.beselaere Health Links CCP registration_update_discharge form July 2018.cfm	,0,1,2,3,4,5,	,0,76,	,0,3,
South West LHIN Home and Community Care Contact Form Currently not available for Accuro. Please contact info@partneringforquality.ca for more information. Posted Nov 22, 2018 by ian.hicks Physician Notification of Concern Compliment.pdf SWLHIN Physician Notification of Concern Compliment.cfm	,0,1,2,3,4,5,	,0,75,76,	,0,1,3,
South West LHIN Home and Community Care IV medication Orders Currently not available for Accuro. Please contact info@partneringforquality.ca for more information. Posted Nov 22, 2018 by ian.hicks SWLHIN Home and Community Care IV Medication Orders.cfm SWLHIN HCC Home Infusion Parenteral Medication Form.pdf	,0,1,2,3,4,5,	,0,75,	,0,3,1,
South West LHIN/ SJHC London Geriatric Ambulatory Access Team Lab Requisition Currently not available for Accuro and PDF. Please contact info@partneringforquality.ca for more information. Posted Nov 22, 2018 by ian.hicks Lab_Requisition_for_Geriatric_Ambulatory_Access Team_(GAAT)_Referral.cfm	,0,1,2,3,4,5,	,0,51,76,	,0,3,
South West LHIN/ SJHC London Geriatric Ambulatory Access Team Referral Currently not available for Accuro. Please contact info@partneringforquality.ca for more information. Posted Nov 22, 2018 by ian.hicks SWLHIN_SJHC_Geriatric_Ambulatory_Access_Team_(GAAT)_Referral_Form 2018.cfm Specialized_Geriatrics_outpatient_Referral_Form.pdf	,0,1,2,3,4,5,	,0,51,76,	,0,3,1,
Southwestern Public Health (SWPH) Hepatitis C Screening Checklist Accuro (see "How to Import Forms" in the DC Toolkit); Form: South West Public Health- Hepatitis C Screening Checklist- DC ; Publisher: wejerrett Posted Feb 10, 2019 by candice.beselaere South West Public Health- Hepatitis C Checklist- DC.pdf South West Public Health- Hepatitis C Checklist- DC.cfm	,0,2,3,	,0,80,	,0,1,3,
Southwestern Public Health (SWPH) Lyme Disease Notification Form Accuro (see "How to Import Forms" in the DC Toolkit); Form: South West Public Health- Lyme Disease Notification Form- DC ; Publisher: wejerrett Posted Feb 10, 2019 by candice.beselaere South West Public Health- Lyme Disease Notification-DC.pdf South West Public Health- Lyme Disease Notification- DC.cfm	,0,2,3,	,0,80,	,0,1,3,
Southwestern Public Health (SWPH) Reportable Disease Notification Form Accuro (see "How to Import Forms" in the DC Toolkit); Form: South West Public Health- Reportable Disease Notification Form- DC ; Publisher: wejerrett Posted Feb 10, 2019 by candice.beselaere South West Public Health- Reportable Disease Notification- DC.pdf South West Public Health- Reportable Disease Notification- DC.cfm	,0,2,3,	,0,80,	,0,1,3,
Southwestern Public Health (SWPH) Stop Smoking Workshop Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: South West Public Health- Stop Smoking Workshop Referral- DC ; Publisher: wejerrett Posted Feb 10, 2019 by candice.beselaere South West Public Health- Stop Smoking Workshop Fax Referral - DC.pdf South West Public Health- Stop Smoking Workshop Referral- DC.cfm	,0,2,3,	,0,80,	,0,1,3,
Southwestern Public Health (SWPH) TB Notification Form Accuro (see "How to Import Forms" in the DC Toolkit); Form: South West Public Health- TB Notification Form- DC ; Publisher: wejerrett Posted Feb 10, 2019 by candice.beselaere South West Public Health- TB Notification Form- DC.pdf South West Public Health- TB Notification Form- DC.cfm	,0,2,3,	,0,80,	,0,1,3,
South West Regional Wound Care Program / SJHC London Harmonized Risk Assessment Tool (Update Jan 2020) Accuro (see "How to Import Forms" in the DC Toolkit); Form: SWRWCP - SJHC - Harmonized Risk Assessment Tool- DC; Publisher: pdalton Posted Jan 31, 2019 by candice.beselaere SWRWCP - SJHC - Harmonized Risk Assessment Tool - DC.cfm SWRWCP-DiabeticFootRiskAssessmentTool-UpdateJan2020-DC.pdf	,0,1,2,3,4,5,	,0,76,	,0,3,1,
South West Regional Wound Care Program Diabetic Foot Ulcer Referral Form (Update Jan 2020) Accuro (see "How to Import Forms" in the DC Toolkit); Form: SWRWCP - Diabetic Foot Ulcer Referral Form- DC; Publisher: pdalton Posted Dec 14, 2018 by candice.beselaere SWRWCP - Diabetic Foot Ulcer Referral Form - DC.cfm SWRWCP - Diabetic Foot Ulcer Referral Form - DC - Jan 2020 update.pdf	,0,1,2,3,4,5,	,0,76,	,0,3,1,
SJHC London Breast Assessment Request Form Accuro (see "How to Import Forms" in the DC Toolkit); Form: St. Joseph's Health Care, London - Breast Assessment Request Form -DC ; Publisher: wejerrett Posted Nov 14, 2018 by ian.hicks SJHC - Breast Assessment Request Form-DC.pdf SJHC - Breast Assessment Request Form - DC.cfm	,0,1,	,0,82,	,0,1,3,
SJHC London Nuclear Medicine PET/CT Request Form Accuro (see "How to Import Forms" in the DC Toolkit); Form: St. Joseph's Health Care, London - Nuclear Medicine PET/CT Request Form - DC ; Publisher: wejerrett Posted Nov 14, 2018 by ian.hicks SJHC - Nuclear Medicine PET_CT Request Form- DC.pdf SJHC - Nuclear Medicine PET_CT Request Form - DC.cfm	,0,1,	,0,82,	,0,1,3,
St Thomas Clinic 217 Suboxone Initiation Referral Form Currently not available for Accuro. Please contact info@partneringforquality.ca for more information. Posted Nov 22, 2018 by ian.hicks Clinic 217 - Suboxone Initiation Referral - DC.pdf Clinic_217_Suboxone_Referral.cfm	,0,3,	,0,63,	,0,1,3,
STEGH Obstetrical and Gynecological Ultrasound Requesition Form Currently not available for Accuro. Please contact info@partneringforquality.ca for more information. Posted Nov 22, 2018 by ian.hicks St. Thomas Ob Gyn Ultrasound Requisition - DC.pdf STEGH OB_GYN Ultrasound Req.cfm	,0,3,	,0,63,	,0,1,3,
South West LHIN - IV Antibiotic Referral (Updated Jan 2021) Accuro (see "How to Import Forms" in the DC Toolkit); Form: South West LHIN- IV Antibiotic Referral Form 2021; Publisher: wejerrett Posted Apr 06, 2020 by Partnering for Quality - Digital Coalition Patient Information IV Therapy.pdf South West LHIN - IV Antibiotic Referral Form 2021 - DC.cfm South West LHIN - IV Antibiotic Referral Form 2021 - DC.pdf	,0,1,2,3,4,5,	,0,75,	,0,1,3,1,
South West LHIN - Symptom Response Kit Accuro (see "How to Import Forms" in the DC Toolkit); Form: South West LHIN-Symptom Response Kit (SRK) Prescription Guidelines-DC ; Publisher: wejerrett Posted Jun 14, 2019 by candice.beselaere South West LHIN - Symptom Response Kit - DC.pdf South West LHIN - Symptom Response Kit (SRK) Prescription Form - DC.cfm	,0,1,2,3,4,5,	,0,75,	,0,1,3,
South West LHIN - Community Orders for MAID Accuro (see "How to Import Forms" in the DC Toolkit); Form: South West LHIN - Community Orders for MAID - DC ;Publisher: wejerrett Posted Jun 14, 2019 by candice.beselaere South West LHIN - Community Orders for MAID - DC.cfm South West LHIN - Community Orders for MAID - DC.pdf	,0,1,2,3,4,5,	,0,75,	,0,3,1,
SJHC London - ABI Physiatry Referral Form Accuro (see "How to Import Forms" in the DC Toolkit); Form: SJHC - Physiatry (ABI) Referral - DC ; Publisher: wejerrett Posted Jun 14, 2019 by candice.beselaere SJHC - ABI Physiatry Referral - DC.cfm SJHC - ABI Physiatry Referral Form - DC.pdf	,0,1,	,0,82,	,0,3,1,
SJHC London - Colposcopy Clinic Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: SJHC-Colposcopy Clinic Referral-DC ; Publisher: wejerrett Posted Jun 14, 2019 by candice.beselaere@lhins.on.ca SJHC - Colposcopy Clinic Referral - DC.cfm SJHC - Colposcopy Clinic Referral - DC.pdf	,0,1,	,0,,	,0,3,1,
SJHC London - Pulmonary Function Test Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: SJHC-Pulmonary Function Test Referral-DC ; Publisher: wejerrett Posted Jun 14, 2019 by info@partneringforquality.ca SJHC London-Pulmonary Function (PFT) Test Referral-DC.pdf SJHC - Pulmary Function Test Referral - DC.cfm	,0,1,9,	,0,82,	,0,1,3,
Middlesex London Health Unit-Reportable Disease Notification Form - UPDATED 2025 Accuro (see "How to Import Forms" in the DC Toolkit) ; Form: Middlesex London Health Unit-Reportable Disease Notification Form 2025-DC ;Publisher: wejerrett Posted Feb 28, 2025 by info@partneringforquality.ca Middlesex London Health Unit- Reportable Disease Notification Form 2025- DC.pdf Middlesex London Health Unit- Reportable Disease Notification Form 2025- DC.cfm	,0,1,	,0,56,	,0,1,3,
Middlesex London Health Unit-Positive TB Skin Test IGRA Accuro (see "How to Import Forms" in the DC Toolkit); Form: Middlesex London Health Unit-Positive TB Skin Test/IGRA-DC ; Publisher: wejerrett Posted Jun 14, 2019 by candice.beselaere Middlesex London Health Unit-Positive TB Skin Test_IGRA Report-DC.cfm Middlesex London Health Unit - Positive TB Skin Test IGRA - DC.pdf	,0,1,	,0,56,	,0,3,1,
FIT Colon Cancer Test - Lab Requisition ee "How to Import Forms" in the DC Toolkit); Form: FIT Colon Cancer Test - Lab Requisition; Publisher: wejerrett Posted Jun 24, 2019 by candice.beselaere FIT Colon Cancer Test - Lab Requisition.cfm FIT Colon Cancer Test - Lab Requisition.pdf	,0,1,2,3,4,5,	,0,63,	,0,3,1,
Middlesex London Health Unit Latent TB Medication Prescription Accuro (see "How to Import Forms" in the DC Toolkit); Form: Middlesex London Health Unit-Latent TB Medication Prescription-DC; Publisher: wejerrett Posted Jun 24, 2019 by candice.beselaere Middlesex London Health Unit - Latent TB Medication Prescription - DC.cfm Middlesex London Health Unit - Latent TB Medication Prescription - DC.pdf	,0,1,	,0,56,	,0,3,1,
Health Links- Registration and CCP Entry Accuro (see "How to Import Forms" in the DC Toolkit); Form: Health Links-Registration and CCP Entry-DC ; Publisher: wejerrett Posted Jun 24, 2019 by candice.beselaere Health Links-Registration and CCP Entry-DC.cfm HealthLinks-RegistrationandCCPEntry-DC.pdf	,0,1,2,3,4,5,	,0,75,	,0,3,1,
South West LHIN - IV Hydration Order Form Accuro (see "How to Import Forms" in the DC Toolkit); Form: South West LHIN - IV Hydration Order Form - DC; Publisher: wejerrett Posted Oct 15, 2019 by candice.beselaere South West LHIN - IV Hydration Order Form - DC.pdf South West LHIN - IV Hydration Order Form - DC.cfm SW LHIN IV Antibiotic Order Form Patient Informaiton.pdf	,0,1,2,3,4,5,	,0,75,	,0,1,3,1,
Middlesex London Health Unit - Healthy Babies Healthy Children Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: Middlesex London Health Unit - Health Babies Healthy Children Referral - DC; Publisher: wejerrett Posted Oct 15, 2019 by candice.beselaere MLHU- Healthy Babies Healthy Children Referral-DC.pdf Middlesex London Health Unit- Healthy Babies Healthy Children Referral- DC.cfm	,0,1,	,0,56,	,0,1,3,
HPHA - Heart Failure Clinic Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: Huron-Perth - Heart Failure Clinic Referral - DC ; Publisher: pdalton Posted Oct 15, 2019 by candice.beselaere Huron-Perth - Heart Failiure Clinical Referral.pdf Huron-Perth - Heart Failure Clinic Referral - DC.cfm	,0,4,	,0,106,	,0,1,3,
HPHA - Penicillin Reaction Clinic Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: HPHA - Penicillin Reaction Clinic Referral - DC; Publisher: pdalton Posted Oct 15, 2019 by candice.beselaere HPHA - PRC Physician Referral Form_DC.pdf HPHA - Penicillin Reaction Clinic Referral - DC.cfm	,0,4,	,0,106,	,0,1,3,
HPHA - Eating Disorders Outreach Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: HPHA - Eating Disorder Outreach Referral - DC; Publisher: pdalton Posted Oct 15, 2019 by candice.beselaere HPHA - Eating Disorder Outreach Referral - DC_FINAL.pdf HPHA - Eating Disorders Outreach Referral - DC.cfm	,0,4,	,0,106,	,0,1,3,
STEGH - Stroke Prevention Clinic Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: STEGH - Stroke Prevention Clinic Referral - DC; Publisher: wejerrett Posted Oct 15, 2019 by candice.beselaere STEGH - Stroke Prevention Clinic Referral - DC.cfm STEGH - Stroke Prevention Clinic Referral.pdf	,0,3,	,0,86,	,0,3,1,
HPHA - EMG Dr Steckley Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: HPHA - EMG DrStechley Referral - DC; Publisher: pdalton Posted Oct 15, 2019 by candice.beselaere HPHA - EMG Dr Steckley - DC.cfm HPHA - EMG Dr Steckley - DC.pdf	,0,4,	,0,106,	,0,3,1,
Choosing Wisely - Delayed Prescription Accuro (see "How to Import Forms" in the DC Toolkit); Form: Choosing Wisely - Delayed Prescription; Publisher: pdalton Posted Oct 15, 2019 by candice.beselaere Delayed-Prescription-EN-.pdf Delayed Prescription.cfm	,0,1,2,3,4,5,	,0,63,	,0,1,3,
Choosing Wisely - Viral Prescription Accuro (see "How to Import Forms" in the DC Toolkit); Form: Choosing Wisely - Viral Prescription; Publisher: pdalton Posted Oct 15, 2019 by candice.beselaere Rx-Files-Viral-Prescription-EN.pdf Viral Prescription.cfm	,0,1,2,3,4,5,	,0,63,	,0,1,3,
MOH - MAID Clinician Aid B Accuro (see "How to Import Forms" in the DC Toolkit); Form: MOH - MAID Clinician Aid B - DC; Publisher: wejerrett Posted Oct 28, 2019 by candice.beselaere MOH - MAID Clinician Aid B.cfm MOH - MAID Clinician Aid B.pdf	,0,1,2,3,4,5,	,0,63,	,0,3,1,
MOH - MAID Clinician Aid C Accuro (see "How to Import Forms" in the DC Toolkit); Form: MOH - MAID Clinician Aid C - DC; Publisher: wejerrett Posted Oct 28, 2019 by candice.beselaere MOH - MAID Clinican Aid C.cfm MOH - MAID Clinican Aid C.pdf	,0,1,2,3,4,5,	,0,63,	,0,3,1,
Southwestern Public Health (SWPH) STI Reporting and Information Accuro: See attachment below named: "Accuro_SouthwesternPublicHealth_STI_ReportingandInformation" Posted Nov 27, 2019 by candice.beselaere South West Public Health-Chlamydia Fact Sheet-DC.cfm South West Public Health-Gonorrhea Fact Sheet-DC.cfm South West Public Health-Azithromycin Fact Sheet-DC.cfm South West Public Health-Ceftriaxone Fact Sheet-DC.cfm South West Public Health-Chlamydia Gonorrhea Mandatory Reporting Form-DC.cfm South West Public Health-Workflow for Positive Chlamydia Gonorrhea-DC.cfm South West Public Health-STI Medication Order Form-DC.cfm SWPH_ChlamydiaFactSheet_DC.pdf SWPH_GonorrheaFactSheet_DC.pdf SWPH_AzithromycinFactSheet_DC.pdf SWPH_CeftriaxoneFactSheet_DC.pdf SWPH_CT_GC_ReportForm_DC.pdf SWPH_WorkflowPositiveChlamydiaGonorrhea_DC.pdf SWPH_STI_MedicationOrderForm_DC.pdf AccuroSouthwesternPublicHealth STI ReportingandInformation.pdf	,0,2,3,	,0,80,	,0,3,3,3,3,3,3,3,1,1,1,1,1,1,1,1,
SWLHIN - First Dose and Iron Sucrose Screener Accuro (see "How to Import Forms" in the DC Toolkit); Form: South West LHIN-IV First Dose and Iron Sucrose Screener- DC; Publisher: wejerrett Posted Apr 06, 2020 by phil.dalton SW LHIN-First Dose and Iron Sucrose Screener-DC.pdf Memo_First Dose_Iron SucroseCommunity_2019.pdf South West LHIN - First Dose and Iron Sucrose Screener - DC.cfm	,0,1,2,3,4,5,	,0,75,	,0,1,1,3,
Public Health Ontario – Adverse Event Following Immunization report Accuro (see "How to Import Forms" in the DC Toolkit); Form: Public Health Ontario - Adverse Even Following Immunization (AEFI) Report- DC; Publisher: pdalton Posted Jan 31, 2020 by candice.beselaere Public Health Ontario - Adverse Event Following Immunization (AEFI) Report - DC.cfm PHO-AEFI Report-DC.pdf	,0,1,2,3,4,5,	,0,63,	,0,3,1,
Parkinson Society Southwestern Ontario - Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: Parkinson Society Southwestern Ontario Referral- DC; Publisher: pdalton Posted Jan 31, 2020 by candice.beselaere Parkinson's Society of Southwestern Ontario Referral - DC.cfm ParkinsonSocietySouthwesternOntarioReferral-DC.pdf	,0,1,2,3,4,5,	,0,63,	,0,3,1,
Epilepsy Southwestern Ontario – Seizure Education Program Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: Epilepsy Southwestern Ontaroi - Epilepsy Education Program Referral- DC; Publisher: pdalton Posted Jan 31, 2020 by candice.beselaere Epilepsy Southwestern Ontario - Seizure Education Program Referral - DC.cfm EpilepsySouthwesternOntario-SeizureEducationProgramReferral-DC.pdf	,0,1,2,3,4,	,0,63,	,0,3,1,
HPHA - Stroke Prevention Clinic Accuro (see "How to Import Forms" in the DC Toolkit); Form: HPHA - Stroke Prevention Clinic- DC; Publisher: pdalton Posted Jan 31, 2020 by candice.beselaere HPHA - Stroke Prevention Clinic - DC.cfm	,0,4,	,0,106,	,0,3,
HPHA - FIT Positive Colonoscopy Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: HPHA - FIT Positive Colonoscopy Referral- DC; Publisher: pdalton Posted Jan 31, 2020 by candice.beselaere HPHA - FIT Positive Referral - DC.cfm HPHA-FitPositiveColonoscopyReferral-DC.pdf	,0,4,	,0,106,	,0,3,1,
STEGH - Diabetes Education Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: STEGH Diabetic Education Program Referral- DC; Publisher: pdalton Posted Jan 31, 2020 by candice.beselaere STEGH - Diabetic Education Program Referral - DC.cfm STEGH Diabetic Ed Program Referral DC.pdf	,0,3,	,0,86,	,0,3,1,
LHSC - Orthopedic Trauma Foot and Ankle Surgery Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: LHSC - Orthopedic Trauma Foot and Ankle Surgery Referral - DC; Publisher: pdalton Posted Jan 31, 2020 by candice.beselaere LHSC - Orthopedic Trauma Foot and Ankle Surgery Referral - DC.cfm LHSC-OrthopedicTraumaFootAndAnkleSurgery-DC.pdf	,0,1,	,0,51,	,0,3,1,
Grey-Bruce Audiology Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: Grey Bruce Audiology Referral; Publisher: jkruiderink Posted Jan 31, 2020 by candice.beselaere Grey-Bruce Audiology Referral - DC.cfm Grey-Bruce Audiology Referral - DC.pdf	,0,5,	,0,63,	,0,3,1,
Primary Care Rheumatology (Dr. Welch) Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: Dr. Welch Primary Care Rheumatology Referral- DC; Publisher: pdalton Posted Jan 31, 2020 by candice.beselaere Primary Care Rheumatology (Dr. Welch) Referral - DC.cfm Primary Care Rheumatology DrWelchReferral-DC.pdf	,0,1,	,0,63,	,0,3,1,
London Spine Centre Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: London Spine Centre-Referral-DC; Publisher: wejerrett-DC Posted Mar 07, 2020 by Partnering for Quality - Digital Coalition London Spine Centre Referral - DC.cfm London Spine Centre Referral - DC.pdf	,0,1,2,3,4,5,	,0,63,	,0,3,1,
STEGH - X-Ray/Ultrasound/BMD Requisition Accuro (see "How to Import Forms" in the DC Toolkit); Form: STEGH - XR US BMD Requisition; Publisher: wejerrett-DC Posted Mar 07, 2020 by Partnering for Quality - Digital Coalition STEGH - XR US BMD Requisition - DC.cfm STEGH - XR US BMD Requisition - DC.pdf	,0,1,2,3,	,0,,	,0,3,1,
Public Health Ontario COVID-19 Virus Test Requisition (update May 5, 2020) In Accuro: download “Public Health Ontario - COVID 19 Virus Test Requisition 0405202-DC” under publisher “wejerrett” dated 2020-May-05 in your Accuro forms repository Posted May 05, 2020 by Partnering for Quality - Digital Coalition 2019-ncov-test-requisition-Apr 25.pdf Public Health Ontario - COVID-19 Virus Test Requisition.cfm	,0,1,2,3,4,5,	,0,63,	,0,1,3,
Southwestern Public Health (SWPH) ARI/COVID-19 Notification Form (Update Aug 25, 2020) Accuro (see "How to Import Forms" in the DC Toolkit); Form: Southwestern Public Health- COVID-19 ARI Form 08242020- DC; Publisher: wejerrett Posted May 20, 2020 by Partnering for Quality - Digital Coalition Southwestern Public Health - COVID19 ARI Notification Form 08242020 - DC.cfm Southwestern Public Health_COVID19 ARINotification FORM 20200824-DC.pdf	,0,2,3,	,0,80,	,0,3,1,
North York General Hospital (NYGH) Prenatal Screening Requisition Accuro (see "How to Import Forms" in the DC Toolkit); Form: "Lab, North York General Prenatal Screening"; Publisher: “akalbfleisch” Posted Apr 01, 2020 by phil.dalton@lhins.on.ca North York General Hospital - Prenatal Screening Requisition - DC.cfm North York General Hospital - Prenatal Screening Requisition - DC.pdf	,0,1,2,3,4,5,	,0,63,	,0,3,1,
STEGH Cardio-Respiratory Department Requisition 2020 Accuro (see "How to Import Forms" in the DC Toolkit); Form: "STEGH Cardio-Respiratory Department Requisition 2019 - DC;"; Publisher: pdalton Posted Nov 12, 2020 by Digital Coalition STEGH - Cardio-Resp Requisition - DC.pdf STEGH Cardio-Respiratory Department Requisition 2020.cfm	,0,2,3,	,0,,	,0,1,3,
STEGH - Pulmonary Function Testing Requisition Accuro (see "How to Import Forms" in the DC Toolkit); Form: "STEGH- Pulmonary Function Testing Requisition- DC"; Publisher: wejerrett Posted Nov 12, 2020 by Digital Coalition STEGH -Pulmonary Function Requisition - DC.pdf STEGH - Pulmonary Function Testing Requisition - DC.cfm STEGH PFT Patient Intructions (Specialty TestsMethacholine).pdf STEGH PFT Patient Intructions (SpirometryPFT).pdf	,0,2,3,	,0,86,	,0,1,3,1,1,
KMH Cardiology Centres Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: "KMH Cardiology Centres Referral 2020 - DC"; Publisher: pdalton Posted Nov 12, 2020 by Digital Coalition KMH Cardiology Centres Referral 2020 - DC.cfm KMH Fillable-Req-Consult-Aug20.pdf	,0,1,2,3,	,0,,	,0,3,1,
Ontario Healthy Heart London Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: "Ontario Healthy Heart- Referral Form- DC"; Publisher: wejerrett Posted Nov 12, 2020 by Digital Coalition Ontario Healthy Heart London Referral - DC.pdf Ontario Healthy Heart London Referral - DC.cfm	,0,1,	,0,63,	,0,1,3,
Dr Ahmed Ziada Consultation Requisition Accuro (see "How to Import Forms" in the DC Toolkit); Form: "Dr Ahmed Ziada Consultation Requisition - DC"; Publisher: wejerrett Posted Nov 12, 2020 by Digital Coalition Dr Ziada Internal Medicine Referral - DC.pdf Dr Ahmed Ziada Consultation Requisitoin - DC.cfm	,0,2,3,	,0,,	,0,1,3,
Primary Care Skin Disorders Clinic Accuro (see "How to Import Forms" in the DC Toolkit); Form: SKIN DISORDERS CLINIC - Referral Form - DC; Publisher: wejerrett Posted Nov 12, 2020 by Digital Coalition Dr Howard Dr Bhanji - Skin Disorders Clinic Referral - DC.pdf Dr Howard Dr Bhanji - Skin Disorders Clinic Referral - DC.cfm	,0,1,	,0,,	,0,1,3,
LHSC – Children’s Ultrasound Fluoroscopy Xray Requisition Accuro (see "How to Import Forms" in the DC Toolkit); Form: "LHSC Children's Hospital - Children's Ultrasound Fluoroscopy Xray Requisition"; Publisher: kelseyhern Posted Nov 12, 2020 by Digital Coalition LHSC - Childrens Ultrasound Fluoroscopy Xray Requisition - DC.pdf LHSC - Childrens Ultrasound Fluoroscopy Xray Requisition - DC.cfm	,0,1,2,3,4,5,	,0,51,	,0,1,3,
SJHC London Interventional Radiology Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: "SJHC - Interventional Radiology Referral Form 2019 - DC"; Publisher: wejerrett Posted Nov 12, 2020 by Digital Coalition SJHC - Interventional Radiology Referral - DC.pdf SJHC - Interventional Radiology Referral - DC.cfm	,0,1,2,3,4,5,	,0,82,	,0,1,3,
SJHC London General Radiology Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: "SJHC - General Radiology Referral 2020 - DC"; Publisher: wejerrett Posted Mar 02, 2021 by Digital Coalition SJHC - General Radiology Referral 2020 - DC.cfm Radiology Referral Form General Radiology.pdf	,0,1,2,3,4,	,0,82,	,0,3,1,
MTO - Medical Condition Report 2020 Accuro (see "How to Import Forms" in the DC Toolkit); Form: "MTO - Medical Condition Report - DC"; Publisher: wejerrett Posted Nov 12, 2020 by Digital Coalition MTO Medical Condition Report.pdf MTO - Medical Condition Report 2020 - DC.cfm	,0,1,2,3,4,5,	,0,62,	,0,1,3,
Ontario Ministry of Long Term Care - LHIN Health Assessment Accuro (see "How to Import Forms" in the DC Toolkit); Form: "Ontario MoLTC - LHIN Health Assessment"; Publisher: wejerrett Posted Nov 12, 2020 by Digital Coalition Ontario MoLTC - LHIN Health Assessment - DC.pdf Ontario MoLTC - LHIN Health Assessment - DC.cfm	,0,1,2,3,4,5,	,0,62,	,0,1,3,
Canadian Revenue Agency - Disability Tax Credit Application Currently unavailable in Accuro Posted Nov 12, 2020 by phil.dalton@lhins.on.ca CRA - Disability Tax Credit Certificate Application.pdf CRA - Disability Tax Credit Application.cfm	,0,1,2,3,4,5,	,0,62,	,0,1,3,
Middlesex Hospital Alliance Endoscopy Unit Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: "Middlesex Hospital Alliance - Endoscopy Unit Referral - DC"; Publisher: pdalton Posted Nov 12, 2020 by Digital Coalition Middlesex Hospital Alliance - Endoscopy Unit Referral - DC.cfm	,0,1,	,0,34,88,	,0,3,
Dr Sardar Weight Management Program Requisition Accuro (see "How to Import Forms" in the DC Toolkit); Form: "Dr. Sardar Requisition Form for Weight Management Program Requisition - DC"; Publisher: wejerrett Posted Nov 12, 2020 by Digital Coalition Dr Sardar Weight Management Program Requisition - DC.pdf Dr Sardar Weight Management Program Requisition - DC.cfm	,0,2,3,	,0,63,	,0,1,3,
Dr Sardar Chest Pain Assessment Clinic Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: "Dr Sardar Chest Pain Assessment Clinic - DC"; Publisher: wejerrett Posted Nov 12, 2020 by Digital Coalition Dr Sardar Chest Pain Assessment Clinic Referral - DC.pdf Dr Sardar Chest Pain Assessment Clinic Referral - DC.cfm	,0,2,3,	,0,63,	,0,1,3,
LHSC Medical Genetics Requisition Accuro (see "How to Import Forms" in the DC Toolkit); Form: "LHSC Medical Genetics Requisition 2020 - DC"; Publisher: pdalton Posted Nov 12, 2020 by Digital Coalition LHSC - Medical Genetics Requisition 2020 - DC.pdf LHSC - Medical Genetics Requisition 2020 - DC.cfm	,0,1,2,3,4,5,	,0,51,	,0,1,3,
South West Regional Cancer Program- Lung Diagnostic Assessment Program Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: "CCO SW Regional Cancer Program- Lung Diagnostic Assessment Program (TDAP) Referral- DC"; Publisher: wejerrett Posted Nov 12, 2020 by Digital Coalition CCO SW Regional Cancer Program – Lung Diagnostic Assessment (TDAP) Referral– DC.pdf CCO Lung Diagnostic Assessment Program (TDAP) Referral.cfm	,0,1,2,3,4,5,	,0,51,63,	,0,1,3,
LHSC / SJHC Nuclear Medicine Requisition Accuro (see "How to Import Forms" in the DC Toolkit); Form: "LHSC- SJHC Nuclear Medicine Requisition- DC"; Publisher: wejerrett Posted Nov 12, 2020 by Digital Coalition LHSC-SJHC - Nuclear Medicine Requisition - DC.pdf LHSC-SJHC - Nuclear Medicine Requisition - DC.cfm	,0,1,2,3,4,5,	,0,63,	,0,1,3,
EMG London - Dr. Lacerte Accuro (see "How to Import Forms" in the DC Toolkit); Form: "• EMG London - Dr. Lacerte - DC"; Publisher: pdalton Posted Nov 12, 2020 by Digital Coalition Dr Lacerte London - EMG Requisition - DC.pdf EMG London - Dr. Lacerte - DC.cfm	,0,1,	,0,63,	,0,1,3,
Dr Lacerte Physical Medicine and Rehabilitation Consultation Requisition Accuro (see "How to Import Forms" in the DC Toolkit); Form: "Lacerte Consultation & Procedues Request 2020"; Publisher: blesauvage Posted Nov 12, 2020 by Digital Coalition Dr Lacerte London-PM R Consult Requisition 2020 - DC.pdf PM R Consultation Requisition - Dr Lacerte London 2020 - DC.cfm	,0,1,	,0,,	,0,1,3,
South West LHIN Palliative Care Outreach Team (Oxford/Elgin) Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: "South West LHIN - Oxford Elgin Palliative Care Outreach Team Referral - DC"; Publisher: wejerrett Posted Nov 12, 2020 by Digital Coalition South West LHIN - Oxford Elgin Palliative Care Outreach Team Referral - DC.cfm	,0,2,3,	,0,,	,0,3,
STEGH - Adult Mental Health Services Accuro (see "How to Import Forms" in the DC Toolkit); Form: "STEGH - Adult Mental Health Services"; Publisher: wejerrett Posted Nov 12, 2020 by Digital Coalition STEGH - Adult Mental Health Services Referral - DC_IA.pdf STEGH - Adult Mental Health Services Referral - DC.cfm	,0,1,2,3,4,5,	,0,86,	,0,1,3,
LHSC Vascular Flow Lab Requisition Accuro (see "How to Import Forms" in the DC Toolkit); Form: "LHSC - Vascular Flow Lab Requisition - DC"; Publisher: wejerrett Posted Nov 12, 2020 by Digital Coalition LHSC - Vascular Flow Lab Requisition - DC.pdf LHSC - Vascular Flow Lab Requisition - DC.cfm	,0,1,2,3,4,5,	,0,51,	,0,1,3,
Diabetes Canada Prescription for Cardiovascular Protection with Diabetes Accuro (see "How to Import Forms" in the DC Toolkit); Form: "Diabetes Canada Prescription for Cardiovascular Protection with Diabetes - DC"; Publisher: wejerrett Posted Nov 12, 2020 by Digital Coalition Diabetes Canada - Rx for Cardio Protection - DC.pdf Diabetes Canada - Rx for Cardiovascular Protection - DC.cfm	,0,1,2,3,4,5,	,0,63,	,0,1,3,
Diabetes Canada Insulin Prescription Accuro (see "How to Import Forms" in the DC Toolkit); Form: "Diabetes Canada - Insulin Rx - DC"; Publisher: pdalton Posted Nov 12, 2020 by Digital Coalition Diabetes Canada - Insulin Rx - DC.pdf Diabetes Canada - Insulin Rx - DC.cfm	,0,1,2,3,4,5,	,0,63,	,0,1,3,
Public Health Ontario - COVID-19 Serology Test Requisition Accuro (see "How to Import Forms" in the DC Toolkit); Form: "Public Health Ontario - COVID-19 Serology Test Requisition"; Publisher: wejerrett Posted Nov 12, 2020 by Digital Coalition Public Health Ontario - COVID-19 SerologyTest Requisition.pdf Public Health Ontario - COVID-19 Serology Test Requisition.cfm	,0,1,2,3,4,5,	,0,63,	,0,1,3,
Middlesex London Health Unit Animal Exposure Incident Report Form Accuro (see "How to Import Forms" in the DC Toolkit); Form: "Middlesex London Health Unit-Animal Exposure Incident Report-DC"; Publisher: wejerrett Posted Nov 12, 2020 by Digital Coalition Middlesex London Health Unit-Animal Exposure Incident Report-DC.pdf Middlesex London Health Unit-Animal Exposure Incident Report-DC.cfm	,0,1,	,0,56,	,0,1,3,
LHSC Radiologic Consultation Accuro (see "How to Import Forms" in the DC Toolkit); Form: "LHSC - Radiologic Consultation - DC"; Publisher: wejerrett Posted Jan 31, 2020 by phil.dalton LHSC - Radiologic Consultation - DC.cfm	,0,1,	,0,51,	,0,3,
Huron County Community Paramedic Program Referral Currently unavailable in Accuro. Please contact info@partneringforquality.ca for more information. Posted Dec 09, 2020 by Digital Coalition Huron County Community Paramedic Program Referral - DC.pdf Huron County Community Paramedic Program Referral - DC.cfm	,0,4,	,0,,	,0,1,3,
Adverse Event Following Immunization (AEFI) Report 2020 Accuro (see "How to Import Forms" in the DC Toolkit); Form: "Public Health Ontario - Adverse Event Following Immunization (AEFI) Report 2020 - DC"; Publisher: pdalton Posted Dec 31, 2020 by Digital Coalition Public Health Ontario - Adverse Event Following Immunization (AEFI) Report 2020 - DC.cfm aefi-reporting-form.pdf	,0,6,7,8,9,10,	,0,63,	,0,3,1,
Dr. Fernando Psychiatry Woodstock Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: "Dr. Fernando Psychiatry Woodstock Referral - DC"; Publisher: pdalton Posted Dec 31, 2020 by Digital Coalition Dr. Fernando Psychiatry Woodstock Referral - DC.cfm Fernando-Referral.pdf	,0,1,2,3,9,	,0,63,	,0,3,1,
COVID-19 Patient Vaccination Searches and Consents For Accuro: See below document for current information. Note that ".srx" files are specific to Telus PS EMR searches. Refer to the "Importing Searches PS" for more information. Posted Mar 22, 2021 by Partnering for Quality - Digital Coalition Video PS Search.mp4 Video Accuro Search.mp4 Importing Searches PS.pdf Importing Searches in Accuro.pdf MOH - COVID-19 Vaccine Screening and Consent March 2021 - DC.cfm Patients 80 and over - DC.srx Patients age 75-79 - DC.srx Patients age 70-74 - DC .srx Patients age 65-69 - DC.srx Patients age 60-64 - DC.srx MOH - COVID-19 Vaccine Screening and Consent March 2021 - DC.pdf ALL FILES - COVID-19 PATIENT VACCINATTION SEARCHES AND CONSENTS - DC.pdf Accuro Patient Vaccination Prioritization Information UPDATED April 22 2021.pdf Patients age 40-59 - DC.srx	,0,,	,0,,	,0,5,5,1,1,3,3,3,3,3,3,1,1,1,3,
LHSC Urgent COVID-19 Care Clinic Referral Form Accuro (see "How to Import Forms" in the DC Toolkit); Form: "LHSC - Urgent COVID-19 Care Clinic Referral - DC"; Publisher: pdalton Posted Apr 05, 2021 by Partnering for Quality - Digital Coalition LHSC - Urgent COVID-19 Care Clinic Referral form.cfm LHSC - Urgent COVID-19 Care Clinic Referral form - DC.pdf	,0,1,	,0,51,	,0,3,1,
Prisma Health Care Collaborative - GROW Program Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form:"Prisma Health Care Collaborative- GROW Program Referral- DCer: wejerrett Posted Apr 22, 2021 by Partnering for Quality - Digital Coalition Prisma Health Care Collaborative - GROW Program Referral - DC.pdf Prisma Health Care Collaborative - GROW Program Referral - DC.cfm	,0,1,	,0,63,	,0,1,3,
Prisma Health Care Collaborative - Primary Care Skin Procedures Clinic Referral 2021 Accuro (see "How to Import Forms" in the DC Toolkit); Form:"Prisma Health Care Collaborative- Primary Care Skin Procedures Clinic Referral 2021- DC"; Publisher: wejerrett Posted Apr 22, 2021 by Partnering for Quality - Digital Coalition Prisma Health Care Collaborative - Primary Care Skin Procedures Clinic Referral 2021 - DC.pdf Prisma Health Care Collaborative - Primary Care Skin Procedures Clinic Referral 2021 - DC.cfm	,0,1,	,0,63,	,0,1,3,
LRCP New Patient Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form:"LRCP - New Patient Referral - DC"; Publisher: pdalton Posted May 21, 2021 by Partnering for Quality - Digital Coalition LRCP - New Patient Referral - DC.pdf LRCP - New Patient Referral - DC.cfm	,0,1,2,3,4,5,9,	,0,51,	,0,1,3,
Public Health Ontario - HIV Serology PCR Test Requisition - DC Accuro (see "How to Import Forms" in the DC Toolkit); Form: " Public Health Ontario - HIV Serology PCR Test Requisition - DC"; Publisher: pdalton Posted Jun 21, 2021 by pdalton LR-Public_Health_Ontario_HIV_Serology_Test_Requisition[1].cfm	,0,,	,0,,	,0,1,
South Western Public Health - COVID 19 Vaccine - Third Dose Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: Southwestern Public Health-COVID 19 Vaccine Third Dose Patient Referral Form-DC ; Publisher: wejerrett Posted Sep 08, 2021 by Partnering for Quality - Digital Coalition Southwestern Public Health- COVID19 Vaccine Third Dose Patient Referral Form- DC.cfm SWPH_Third COVID19 Vaccine Referral Form_DC.pdf	,0,2,3,	,0,80,	,0,3,1,
LHSC - Paediatric Virtual COVID Clinic Assessment Request Form Accuro (see "How to Import Forms" in the DC Toolkit); Form: LHSC Children's Hospital- Paediatric Virtual COVID Clinic Assessment- DC Jan 7 2022; Publisher: wejerrett Posted Jan 07, 2022 by Partnering for Quality - Digital Coalition LHSC Children's Hospital- Paediatric Virtual COVID Clinic Assessment- DC Jan 7 2022.cfm LHSC Childrens Hospital -Paediatric Virtual COVID Clinic Assessment - DC Jan 2022.pdf	,0,1,	,0,51,	,0,3,1,
South West HCCSS- COVID19 Remote Care Monitoring Program Adults Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: South West HCCSS- COVID19 Remote Care Monitoring Program Adults Referral Form- DC; Publisher: wejerrett Posted Jan 07, 2022 by Partnering for Quality - Digital Coalition South West HCCSS- COVID19 Remote Care Monitoring Program Adults Referral Form- DC.cfm South West HCSS - COVID19 Remote Care Monitoring Program Adults Referral Form- DC.pdf	,0,1,2,3,4,5,	,0,63,	,0,3,1,
LHSC- Sleep and Apnea Assessment Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: LHSC- Sleep and Apnea Assessment Referral- DC Jan 2022 ; Publisher: wejerrett Posted Jan 17, 2022 by info@partneringforquality.ca LHSC - Sleep & Apnea Assessment Referral 2021.cfm LHSC Sleep and Apnea Assessment Referral_dc.pdf	,0,1,3,9,	,0,51,	,0,3,1,
Paxlovid Prescription Accuro (see "How to Import Forms" in the DC Toolkit); Form: "Paxlovid Prescription- 04122022- DC"; Publisher: wejerrett Posted Apr 13, 2022 by info@partneringforquality.ca Paxlovid Prescription Form - 041222- DC.pdf Paxlovid Prescription- 04122022- DC.cfm	,0,10,	,0,63,	,0,1,3,
CAC Outpatient Therapy Referral Form Accuro (see "How to Import Forms" in the DC Toolkit); Form: "CAC Outpatient Therapy Referral Form-20220502-DC"; Publisher: wejerrett Posted May 16, 2022 by info@partneringforquality.ca CAC Outpatient Therapy Referral Form-20220502-DC.cfm CAC Outpatient Therapy Referral Form 2022-05-02.pdf	,0,10,	,0,,	,0,3,1,
Arbeau Sports Medicine Centre (London) Accuro (see "How to Import Forms" in the DC Toolkit); Form: "Arbeau Sports Medicine Centre London Referral-DC"; Publisher: cbeselaere Posted Jul 14, 2022 by info@partneringforquality.ca Arbeau Sports Medicine Centre-Referral-London-DC.pdf Arbeau Sports Medicine Centre-Referral-London.cfm	,0,1,9,10,	,0,,	,0,1,3,
SJHC London- Cardio Vascular Investigation Unit Referral Form Accuro (see "How to Import Forms" in the DC Toolkit); Form: "SJHC London-Cardio Vascular Investigation Unit Referral-DC"; Publisher: cbeselaere Posted Jul 14, 2022 by info@partneringforquality.ca SJHC London-Cardio Vascular Investigation Unit Referral-DC.pdf SJHC London-Cardio Vascular Investigation Unit Referral-DC.cfm	,0,1,9,10,	,0,82,	,0,1,3,
SJHC London COPD and Pulmonary Rehabilitation Referral Form Accuro (see "How to Import Forms" in the DC Toolkit); Form: "SJHC London-COPD and Pulmonary Rehabilitation Referral-DC"; Publisher: cbeselaere Posted Jul 14, 2022 by info@partneringforquality.ca SJHC London-COPD and Pulmonary Rehabilitation Program Referral-DC.pdf SJHC London-COPD and Pulmonary Rehabilitation Program Referral-DC.cfm	,0,1,9,10,	,0,82,	,0,1,3,
SJHC London Pain Clinic Referral Form Accuro (see "How to Import Forms" in the DC Toolkit); Form: "SJHC London-Pain Clinic Referral-DC"; Publisher: wejerrett Posted Jul 14, 2022 by info@partneringforquality.ca SJHC London-Pain Clinic Referral- DC1.pdf SJHC London-Pain Clinic Referral-DC.cfm	,0,1,9,10,	,0,82,	,0,1,3,
Tandem Referral Form Accuro (see "How to Import Forms" in the DC Toolkit); Form: Tandem Referral Form - March 2023 - DC ; Publisher: wejerrett Posted Apr 10, 2023 by info@partneringforquality.ca Final - Tandem Referral Form.pdf Tandem- Referral Form- March 2023- DC.cfm	,0,1,	,0,63,	,0,1,3,
Ontario Breast Cancer Follow Up Care Clinical Guidelines: Year 1 - 3 Accuro (see "How to Import Forms" in the DC Toolkit); Form: "Ontario Breast Cancer Followup Care Clinical Guidelines-yr1to3-DC"; Publisher: cjabeselaere Posted Jun 16, 2023 by info@partneringforquality.ca Ontario Breast Cancer Follow up Guidelines Year 1-3_DC.cfm Ontario Breast Cancer Followup Care Clinical Guidelines-yr1to3-DC.pdf Modified Ontario Breast Cancer Followup Care Clinical Guidelines (002).pdf	,0,1,2,3,4,5,9,10,	,0,51,63,	,0,3,1,1,
Ontario Breast Cancer Follow Up Care Clinical Guidelines: Year 4+ Accuro (see "How to Import Forms" in the DC Toolkit); Form: "Ontario Breast Cancer Followup Care Clinical Guidelines-yr4-DC"; Publisher: cjabeselaere Posted Jun 16, 2023 by info@partneringforquality.ca Ontario Breast Cancer Follow Up Guidelines Year 4+_DC.cfm Ontario Breast Cancer Followup Care Clinical Guidelines-yr4-DC.pdf Modified Ontario Breast Cancer Followup Care Clinical Guidelines (002).pdf	,0,1,2,3,4,5,9,10,	,0,51,63,	,0,3,1,1,
HCCSS SW- Request for Community Palliative Services Assessment Accuro (see "How to Import Forms" in the DC Toolkit); Form: "HCCSS South West- Request for Community Palliative Services Assessment- DC"; Publisher: wejerrett Posted Aug 24, 2023 by info@partneringforquality.ca HCCSS South West-Request for Community Palliative Services Assessment-DC.cfm HCCSS SW_Palliative Care - Community Services Assessment Request 2023_DC.pdf	,0,1,3,4,5,9,	,0,,	,0,3,1,
LHSC SJHC - Adult URGENT Ambulatory Mental Health and Addictions Referral Form Accuro (see "How to Import Forms" in the DC Toolkit); Form: LHSC SJHC- Adult URGENT Mental Health and Addictions Referral Form- DC ; Publisher: wejerrett Posted Nov 09, 2023 by info@partneringforquality.ca LHSC SJHC- URGENT Adult Ambulatory Mental Health and Addictions Referral Form-DC.pdf LHSC SJHC- Urgent Consutlation Service Mental Health and Addictions Referral - DC.cfm	,0,1,2,3,4,5,9,10,	,0,51,82,	,0,1,3,
LHSC SJHC- Adult NON URGENT Ambulatory Mental Health and Addictions Referral Form Accuro (see "How to Import Forms" in the DC Toolkit); Form: LHSC SJHC- Adult NON URGENT Mental Health and Addictions Referral Form- DC ; Publisher: wejerrett Posted Nov 09, 2023 by info@partneringforquality.ca LHSC SJHC -Non Urgent Ambulatory Mental Health and Addictions Referral Form- DC.cfm LHSC SJHC-Adult Non-Urgent Ambulatory Mental Health and Addictions Referral-DC.pdf	,0,1,2,3,4,5,9,10,	,0,51,82,	,0,3,1,
Public Health Ontario General Test Requisition 2023 Accuro (see "How to Import Forms" in the DC Toolkit); Form: Public Health Ontario_General test Requisition2023_DC ; Publisher: wejerrett Posted Nov 09, 2023 by info@partneringforquality.ca Public Health Ontario_General Test Requisition2023_DC.pdf Public Health Ontario_General Test Requisition 2023_DC.cfm	,0,10,	,0,,	,0,1,3,
Elgin Geriatric Services Integrated Referral Form 2023 Accuro (see "How to Import Forms" in the DC Toolkit); Form: Elgin Geriatric Integrated Referral Form 2023_DC and HANDOUT: Elgin Geriatric Integrated Referral Form 2023_DC ; Publisher: wejerrett Posted Nov 17, 2023 by info@partneringforquality.ca Elgin Geriatric Services Integrated Referral Form 2023_DC.cfm HANDOUT Elgin Geriatric Services Integrated Referral 2023_DC.cfm Elgin Integrated Referral Form Nov15_DC.pdf HANDOUT Elgin Integrated Referral Form Nov 15_DC.pdf	,0,3,	,0,86,	,0,3,3,1,1,
Grey Bruce Geriatric Services Integrated Referral Form Feb 2024-DC Accuro (see "How to Import Forms" in the DC Toolkit); Form: Grey Bruce-Geriatric Services Integrated Referral Form Feb 2024-DC ; Publisher: cjabeselaere Posted Apr 22, 2024 by info@partneringforquality.ca GB- Integrated Referral Form- Feb 2024-DC.cfm Grey Bruce Geriatric Services Integrated Referral Form_DC.pdf	,0,5,	,0,,	,0,3,1,
SJHC- Outpatient Referral Form Diabetes & Endocrinology 2023 Accuro (see "How to Import Forms" in the DC Toolkit); Form: SJHC- Outpatient Referral Form Diabetes & Endocrinology– DC ; Publisher: cjabeselaere Posted May 10, 2024 by info@partneringforquality.ca SJHC- Outpatient Referral Form Diabetes & Endocrinology- DC.cfm SJHC London_Diabetes Endocrinology OPD Referral Form 2023_DC.pdf	,0,1,9,	,0,82,	,0,3,1,
SWHCCSS- Adult Intravenous Remdesivir Infusion Therapy Order Form 2024 Accuro (see "How to Import Forms" in the DC Toolkit); Form: SWHCCSS- Adult Intravenous Remdesivir Infusion Therapy Order Form 2024- DC ; Publisher: cjabeselaere Posted May 10, 2024 by info@partneringforquality.ca SW HCCSS- Adult Intravenous Remdesivir Infusion Therapy Order Form- DC.cfm HCCSS SW Adult Intravenous Remdesivir Infusion Therapy Order Form 2024_DC.pdf	,0,1,2,3,4,5,9,	,0,,	,0,3,1,
Fowler Kennedy Sports Medicine Clinic- Patient Referral Form Accuro (see "How to Import Forms" in the DC Toolkit); Form: Fowler Kennedy Sports Medicine Clinic- Patient Referral Form- DC ; Publisher: cjabeselaere Posted May 10, 2024 by info@partneringforquality.ca FOWLER KENNEDY SPORT MEDICINE CLINIC PATIENT REFERRAL FORM_DC.pdf Fowler Kennedy Sport Medicine Clinic- Patient Referral Form- DC.cfm	,0,1,9,	,0,,	,0,1,3,
Middlesex Hospital Alliance- Diagnostic Imaging Accuro (see "How to Import Forms" in the DC Toolkit); Form: Middlesex Hospital Alliance- Diagnostic Imaging- DC ; Publisher: cjabeselaere Posted May 10, 2024 by info@partneringforquality.ca Middlesex Hospital Alliance- Diagnostic Imaging- DC.cfm Middlesex Hospital Alliance Diagnostic Imaging FORM_DC.pdf	,0,1,3,9,	,0,88,	,0,3,1,
Middlesex Hospital Alliance- Request for Breast Assessment_BMD Accuro (see "How to Import Forms" in the DC Toolkit); Form: Middlesex Hospital Alliance- Request for Breast Assessment_BMD- DC ; Publisher: cjabeselaere Posted May 10, 2024 by info@partneringforquality.ca MHA_Request for Breast Assessment BMD Referral Form_DC.pdf Middlesex Hospital Alliance- Request for Breast Assessment_BMD- DC.cfm	,0,1,3,9,	,0,88,	,0,1,3,
South West Rapid Access Clinic for Low Back Pain Accuro (see "How to Import Forms" in the DC Toolkit); Form: "South West-RAC LBP Referral Form 2024_DC"; Publisher: cjabeselaere Posted Jul 02, 2024 by info@partneringforquality.ca South West- RAC LBP Referral Form- DC.cfm South West- RAC LBP Referral Form.pdf	,0,9,	,0,,	,0,3,1,
HEAR Owen Sound Accuro (see "How to Import Forms" in the DC Toolkit); Form: "HEAR- Owen Sound Referral Form- DC"; Publisher: cjabeselaere Posted Jul 02, 2024 by info@partneringforquality.ca HEAR Owen Sound referral template May 2024_DC.pdf HEAR- Owen Sound Referral Form- DC.cfm	,0,5,	,0,,	,0,1,3,
Bluewater Sleep Disorder Clinic - Pulmonary Function Test Accuro (see "How to Import Forms" in the DC Toolkit); Form: "Bluewater Sleep Disorder Clinic - Pulmonary Function Test- DC"; Publisher: wejerrett Posted Jul 02, 2024 by info@partneringforquality.ca Bluewater Sleep Disorder Clinic- Pulmonary Function Test- DC.cfm	,0,1,6,	,0,,	,0,3,
CMHA Lambton Kent- Single Point Access Referral Accuro (see "How to Import Forms" in the DC Toolkit); Form: "CMHA Lambton Kent- Single Point Access Referral- DC"; Publisher: wejerrett Posted Jul 02, 2024 by info@partneringforquality.ca CMHA Lambton Kent- Single Point Access Referral- DC.cfm	,0,6,	,0,,	,0,3,
STEGH MRI Requisition Accuro (see "How to Import Forms" in the DC Toolkit); Form: "STEGH- MRI Requisition- DC"; Publisher: wejerrett Posted Nov 08, 2024 by info@partneringforquality.ca STEGH- MRI Requisition- DC.cfm STEGH-MRI Requsition- DC.pdf	,0,3,9,	,0,86,	,0,3,1,
South West MSK Rapid Access Clinic Hip and Knee Consult Form (2024) Accuro (see "How to Import Forms" in the DC Toolkit); Form: "SW LHIN- Request for Hip Knee Ortho Consultation- DC" ; Publisher: wejerrett Posted Nov 13, 2024 by info@partneringforquality.ca SW Request for Hip Knee Ortho Consult Form 2024- DC.cfm SW LHIN- Request for Hip Knee Ortho consult form- DC.pdf	,0,1,2,3,4,5,9,	,0,37,51,86,87,88,94,104,	,0,3,1,
St. Joseph's Health Care London Bone Mineral (BMD) Referral Form Density Accuro (see "How to Import Forms" in the DC Toolkit); Form: "SJHC- Bone Mineral Density (BMD) Referral Form- DC"; Publisher: wejerrett Posted Dec 16, 2024 by info@partneringforquality.ca SJHC London- Bone Mineral Density Referral Form- DC.cfm SJHC London- Bone Mineral Density Referral Form- DC1.pdf	,0,1,9,	,0,82,	,0,3,1,
Ontario Health at Home: South West Referral/Request for Assessment Accuro (see "How to Import Forms" in the DC Toolkit); Form: Ontario Health at Home- SW Referral Request for Assessment- DC ; Publisher: wejerrett Posted Feb 06, 2025 by info@partneringforquality.ca Ontario Health at Home- SW Referral Request for Assessment.pdf Ontario Health at Home- SW Referral Request for Assessment- DC.cfm	,0,1,2,3,4,5,9,	,0,,	,0,1,3,
Huron Perth Huron Perth Geriatric Services – Referral Form Accuro (see "How to Import Forms" in the DC Toolkit); Form: Huron Perth-Geriatric Services Integrated Referral 2025- DC-02 ; Publisher: wejerrett Posted Mar 28, 2025 by info@partneringforquality.ca Huron Perth- Geriatric Services Integrated Referral 2025-DC-02.cfm Huron Perth- Geriatric Services Integrated Referral 205- DC- 2.pdf	,0,4,	,0,,	,0,3,1,
Ontario Health West - Outpatients MRI Requisition Accuro (see "How to Import Forms" in the DC Toolkit); Form: OH West- Outpatient MRI Requisition– DC ; Publisher: wejerrett Posted Jul 23, 2025 by info@partneringforquality.ca OH West-Outpatient MRI Requisition- DC.cfm OH West_MRI Requisition_DC.pdf	,0,10,	,0,,	,0,3,1,
Ontario Health West - Outpatients CT Requisition Accuro (see "How to Import Forms" in the DC Toolkit); Form: OH West- Outpatient CT Requisition- DC ; Publisher: wejerrett Posted Jul 23, 2025 by info@partneringforquality.ca OH West-Outpatient CT Requisition- DC.cfm OH West-Outpatient CT Requisition -DC.pdf	,0,10,	,0,,	,0,3,1,
Choosing Wisely - Outpatient CT and MRI Checklists **TO BE USED WITH THE OH WEST CT and MRI Outpatient Requisition as required Accuro and PS - coming soon awaiting confirmation of correct version (July 2025) Posted Jul 23, 2025 by info@partneringforquality.ca South West LHIN - MRIStandardizedRequisitionKneeApproriatenessChecklist (1).pdf South West LHIN-CTStandardizedRequisitionSpineChecklist.pdf South West LHIN-MRIStandardizedRequisitionSpineApproriatenessChecklist.pdf	,0,10,	,0,,	,0,1,1,1,

EMR Resources

Location

Organization

Form Type

Arthritis Society Referral Form

Canadian Mental Health Association Bounce Back Referral Form (Update Jan 2020)

CMHA Elgin Intake Referral Form

Elgin VON Intake Referral Form

HPHA Nuclear Medicine/BMD Requisiton

HPHA Xray/Ultrasound/BMD Requisition

HPHA Breast Imaging Consultation Requisition

Kidney Wise Outpatient Nephrology Referral

Kidney Wise Outpatient Nephrology Referral Lab Requisition

LHSC / SJHC London Ultrasound Requisition

London Pediatric Sleep Clinic - Referral

London Specialists Group (Medpoint) Referral

LRCP - Multidisciplinary Skin Carcinoma Clinic Referral

Ministry of Transportation Medical Condition Report - unfit to drive

South West LHIN - Health Links CCP Referral Form

South West LHIN - Health Links Registration/Update/Discharge Form

South West LHIN Home and Community Care Contact Form

South West LHIN Home and Community Care IV medication Orders

South West LHIN/ SJHC London Geriatric Ambulatory Access Team Lab Requisition

South West LHIN/ SJHC London Geriatric Ambulatory Access Team Referral

Southwestern Public Health (SWPH) Hepatitis C Screening Checklist

Southwestern Public Health (SWPH) Lyme Disease Notification Form

Southwestern Public Health (SWPH) Reportable Disease Notification Form

Southwestern Public Health (SWPH) Stop Smoking Workshop Referral

Southwestern Public Health (SWPH) TB Notification Form

South West Regional Wound Care Program / SJHC London Harmonized Risk Assessment Tool (Update Jan 2020)

South West Regional Wound Care Program Diabetic Foot Ulcer Referral Form (Update Jan 2020)

SJHC London Breast Assessment Request Form

SJHC London Nuclear Medicine PET/CT Request Form

St Thomas Clinic 217 Suboxone Initiation Referral Form

STEGH Obstetrical and Gynecological Ultrasound Requesition Form

South West LHIN - IV Antibiotic Referral (Updated Jan 2021)

South West LHIN - Symptom Response Kit

South West LHIN - Community Orders for MAID

SJHC London - ABI Physiatry Referral Form

SJHC London - Colposcopy Clinic Referral

SJHC London - Pulmonary Function Test Referral

Middlesex London Health Unit-Reportable Disease Notification Form - UPDATED 2025

Middlesex London Health Unit-Positive TB Skin Test IGRA

FIT Colon Cancer Test - Lab Requisition

Middlesex London Health Unit Latent TB Medication Prescription

Health Links- Registration and CCP Entry

South West LHIN - IV Hydration Order Form

Middlesex London Health Unit - Healthy Babies Healthy Children Referral

HPHA - Heart Failure Clinic Referral

HPHA - Penicillin Reaction Clinic Referral

HPHA - Eating Disorders Outreach Referral

STEGH - Stroke Prevention Clinic Referral

HPHA - EMG Dr Steckley Referral

Choosing Wisely - Delayed Prescription

Choosing Wisely - Viral Prescription

MOH - MAID Clinician Aid B

MOH - MAID Clinician Aid C

Southwestern Public Health (SWPH) STI Reporting and Information

SWLHIN - First Dose and Iron Sucrose Screener

Public Health Ontario – Adverse Event Following Immunization report

Parkinson Society Southwestern Ontario - Referral

Epilepsy Southwestern Ontario – Seizure Education Program Referral

HPHA - Stroke Prevention Clinic

HPHA - FIT Positive Colonoscopy Referral

STEGH - Diabetes Education Referral

LHSC - Orthopedic Trauma Foot and Ankle Surgery Referral

Grey-Bruce Audiology Referral

Primary Care Rheumatology (Dr. Welch) Referral

London Spine Centre Referral

STEGH - X-Ray/Ultrasound/BMD Requisition

Public Health Ontario COVID-19 Virus Test Requisition (update May 5, 2020)

Southwestern Public Health (SWPH) ARI/COVID-19 Notification Form (Update Aug 25, 2020)

North York General Hospital (NYGH) Prenatal Screening Requisition

STEGH Cardio-Respiratory Department Requisition 2020

STEGH - Pulmonary Function Testing Requisition

KMH Cardiology Centres Referral

Ontario Healthy Heart London Referral

Dr Ahmed Ziada Consultation Requisition

Primary Care Skin Disorders Clinic

LHSC – Children’s Ultrasound Fluoroscopy Xray Requisition