For completion by physicians, clinicians or other health care agencies.
Before sending this referral, please confirm that your client:
-
Has exhausted extended health benefits or other third party coverage
-
Is not duplicating services from other providers/agencies
-
Is not eligible for other government funded options
-
Is not acutely ill with chest pain, fractures, severe pain, psychosis, active suicidal thoughts, or other illnesses that will require emergency or crisis services
-
Is aware all IPCT services are covered by OHIP
-
Is informed of the IPCT referral
Program criteria can be viewed HERE
