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General practice / Referral


Appendix 1: Ambulatory Care Referral Form To: Dr. *Division *Some Divisions share referrals within the group; may be based on specialty or wait list
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Document Date: 2014-10-02 11:37:39


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Dr. No / /

Organization

No Unit / /

Person

Patient / /

Position

physician in the Division / /

ProvinceOrState

Ontario / /

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