These forms are periodically modified. To make sure you are using the most current version of the form you require, please download it from this webpage.
All referrals must include Part 1 and Part 2 of the form below.
The form is for all referrals to inpatient rehabilitation (high tolerance and low tolerance/slowstream) and CCC, except:
- Elective Total Joint Replacements (continue to use the MSK Preadmission Referral Form)
- Uncomplicated Elective Cardiac Bypass/Valve Surgery at St. John's Rehab Hospital (continue to use existing process/forms at St. John's Rehab Hospital)
- Palliative Care (continue to use existing process/forms)
- E-Stroke (For those organizations that do not have access to the E-Stroke Rehab Referral System, please download the PDF version of the E-Stroke Rehab Referral Form)
- Geriatric Psychiatry Program at Toronto Rehab (continue to use existing process/forms at Toronto Rehab).
- Dialysis Service at Toronto Rehab (use the Dialysis Application Form, in addition to the Inpatient Rehab/CCC Referral Form, below)
- Organizations in the Toronto Central LHIN must use the LHIN's electronic Resource Matching and Referral (RM&R) system. (The referral information required in the electronic referrals is based on the information in the Network's forms.)
Questions? Check our Frequently Asked Questions (FAQ) / Information Sheet.
Readmission? The Rehab/CCC Readmission Tree clarifies the information and processes required when patients are readmitted to rehab or CCC following a transfer to acute care. It takes into consideration medical stability, changes to functional status and what information should be sent to the rehab/CCC program.