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.

• Inpatient Rehab/CCC Referral Form: for referrals to rehab and complex continuing care (CCC)
  
  
• Outpatient/Ambulatory Rehab Referral Form: for referrals to day hospital programs and/or outpatient rehab services where more than one rehab service is required

The smooth and efficient transfer of patients is critical to ensuring individuals have access to appropriate rehabilitation care when they need it.

To increase consistency, efficiency and transparency in the referral process, the Network has created and implemented standardized, easy-to-use referral forms for use by all GTA Rehab Network member organizations.

The forms ensure rehab providers receive appropriate detail on a patient's status and specific rehab/care/medical needs. They also reduce workload for referrers who are referring to multiple programs at different organizations.

The development of these forms has been funded by the Toronto Central LHIN.

Inpatient Rehab/CCC Referral Form

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).
  
• Organizations in the Toronto Central LHIN must now 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.

Outpatient/Ambulatory Rehab Referral Form

Note for Patients and Families: If you are a patient, family member or friend of a patient, please note that most organizations require a healthcare provider to complete the referral form. Please speak to your healthcare professional.

For a complete listing of programs and services, visit Rehab Finder, our searchable database of rehab programs/clinics/services.