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Inpatient Rehab/CCC

The GTA Rehab Network has developed the GTA Rehab Network Integrated Acute Care to Inpatient Rehab/CCC Referral Form for referrals from acute care to inpatient rehab and CCC to replace the GTA Rehab Network's Inpatient Rehab/CCC Referral Form. This referral form was developed to support the implementation of the Provincial Referrals Standards (PRS), which was formally approved by the Chief Executive Officers (CEOs) of the fourteen Local Health Integration Networks (LHINs) in April 2014. Due to regional complexities, the need to allow Cluster customization of the PRS was identified early on in the Standards development process.

The GTA Rehab Network Integrated Acute Care to Inpatient Rehab/CCC Referral Form aligns the Cluster 2 Acute to Rehab/CCC Provincial Standards for inpatient referrals to organizations within the Central, Central East, Central West, Mississauga Halton and Toronto Central LHINs. 

The following referral forms are available for use. Please note: At this time, these forms are for all referrals to inpatient rehabilitation and CCC, except for referrals to 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).

Note: For the small minority of patients who will require inpatient rehab following elective total joint replacement, the TJR Inpatient Rehab Pre-Admission Form is submitted before admission to acute care; however, following surgery the acute care referrer should complete the GTA Rehab Network Integrated Acute Care to Inpatient Rehab/CCC Referral Form and send it to the inpatient rehab program to which the patient is referred. 

Please see Referral Options below for information on how these forms can be used.

NOTE: For all referrals (excluding referrals to ABI inpatient rehabilitation), please fax the referral form directly to the programs being requested. Program details and contact information can be found through Rehab Finder. For ABI inpatient rehabilitation referrals, please visit the Toronto ABI Network website for instructions and fax the completed referral forms to 416-597-7021.

      • This reference guide provides information on:
i) The development of supplementary referral information to align the GTA Rehab Network's previous inpatient referral form with the Provincial Referral Standards;
ii) The referral options that are available for referrals to Rehab/CCC programs within the GTA; and
iii) Descriptive rationale on how each of the fields within the referral form is to be completed.

Referral Options:

Given the various referral arrangements of organizations within the six GTA LHINs, flexibility is needed to accommodate referral variations. Three referral options are outlined below. The preferred referral option is to be determined by Rehab/CCC programs in consultation with referring partners.

NOTE: For all referrals (excluding referrals to ABI inpatient rehabilitation) please fax the referral form directly to the programs being requested. Program details and contact information can be found through Rehab Finder. For ABI inpatient rehabilitation referrals, please visit the Toronto ABI Network website for instructions and fax the completed forms to 416-597-7021.

Referral Option #1
GTA Rehab Network Integrated Acute Care to Inpatient Rehab/CCC Referral Form

The new GTA Rehab Network Integrated Acute Care to Inpatient Rehab/CCC Referrals Form combines the Provincial Referral Standards (Version 2.1) with additional supplementary referral information to facilitate the admission of the patient to inpatient rehab after an acceptance decision has been made. This form is for referral to rehab and CCC programs that use a one-step referral process whereby all referral information (i.e. to support an accept decision and admission) is sent at the time that the referral is initiated. For programs where there are long waitlists, updates to the referral information will likely be required closer to the time of admission. 

Referral Option #2:  
Version 2.1 Cluster 2 Acute to Rehab/CCC Provincial Referral Standards and
GTA Rehab Network Supplemental Referral Information Form are sent separately

Organizations may choose to "de-couple" the sending of the PRS and supplemental referral information such that the PRS alone is sent at the time that the referral is initiated, while the GTA Rehab Network Supplemental Referral Information Form is used to send additional referral information closer to the time of admission. The need for the Supplemental Referral Information Form is determined by the Rehab/CCC program. 

Referral Option #3:  
Version 2.1 Cluster 2 Acute to Rehab/CCC Provincial Referral Standards (PRS)

Organizations that do not need to send supplemental referral information (e.g. intra-organizational referrals) can send the PRS as a stand-alone referral form.