As requisition content can periodically change, please check back regularly for the most up-to-date version.
Cardiology Requisitions
Echocardiogram Requisition (outpatient)
Electrocardiogram and Holter Monitor Requisition
Pacemaker Requisition Form - Request for Device Interrogation
Diagnostic Imaging Requisitions
Bone Mineral Densitometry Requisition
Computerized Tomography Requisition
Diagnostic Imaging Requisition
Magnetic Resonance Imaging Requisition
MRI Appropriateness Checklist
Nuclear Medicine Requisition
Rectal MRI for Cancer Staging Clinical Information Record
Oncology Referral Forms
Oncology New Patient Referral Form
Breast Cancer
Colorectal Cancer
Urology Cancer
Ocean eReferrals
Bluewater Health has begun using the Ocean eReferrals platform. Primary care providers can currently use the electronic referral system to request diagnostic imaging tests, pulmonary function tests and the Musculoskeletal Rapid Assessment Centre, and will receive notification of the appointment assigned to the patient. The system can accommodate instructions and attachments for the patient, and allows better appointment management for the hospital. Other benefits include integration with primary care providers’ Electronic Medical Record (EMR), enhanced notification of referral status and appointment and decreased need for follow-up. The platform will be expanded to other programs, with the hope to include all outpatient areas in the future. If your office has not yet had an opportunity to join the Ocean eReferral network please email ESC-eReferral@lhins.on.ca.
Peripherally Inserted Central Catheter Information and Referral Form
PICC Line Letter to Practitioners - March 2022
Referral Form - Peripherally Inserted Central Catheter (PICC)
Rehabilitation Referral Forms
Community Reintegration Program, Rehabilitation Outpatient Services
Communications Disorders Referral Form for Speech-Language Pathology Services
Other Referral Forms
Eating Disorders Outreach Program Adult Referral Form
Eating Disorders Outreach Program Youth Referral Form
Fecal Immunochemical Test (FIT) Referral Form
Secondary Stroke Prevention Clinic Patient Referral Form
Specialized Geriatric Service Referral Form