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Diabetes

Forms

Criteria

Please review the referral criteria listed on the form and include the required test results and documentation with your referral.

Contact Us

If you have questions or need assistance, please contact:

Sandra Paleczny, Manager
Ambulatory Care
Email: [email protected]
Phone: 519-749-4300, ext. 2910
Fax: 519-749-4448

Endoscopy

Referral Process

Providers can refer patients for endoscopy procedures in two ways:

Refer directly to either a gastroenterologist or general surgeon for consultation and consideration for endoscopy procedures.

For patients with a positive fecal immunochemical test (FIT), refer directly to the WRHN FIT program via central intake for endoscopy – colonoscopy procedure.

Criteria

Endoscopy services primarily target patients with gastrointestinal (GI) symptoms such as unexplained abdominal pain, bleeding, anemia, or abnormal imaging/lab results. It performs examinations of the stomach and digestive system.

Referral criteria typically include a completed referral form, relevant clinical history, and recent lab results (e.g., CBC, iron studies) or imaging, depending on the indication. In some cases, pre-procedure testing such as medication adjustments (e.g., anticoagulants), or informed consent may also be required.

Geriatric Medically Complex Clinic

Forms

Criteria

This program helps seniors with complex medical conditions. It provides:

  • geriatric assessments
  • diagnoses
  • treatment recommendations

Typical concerns include balance and fall prevention, medication management, continence, and memory. It also provides strategies to help caregivers cope.

Please review the referral criteria listed on the form and include the required test results and documentation with your referral.

Contact Us

If you have questions or need assistance, please contact:

Sandra Paleczny, Manager
Ambulatory Care
Email: [email protected]
Phone: 519-749-4300

Internal Medicine Clinic (GIMRAC) & Non-Malignant Hematology Clinic

Forms

Criteria

These clinics provide expedited access to general internal medicine consultations for outpatients.

Contact Us

If you have questions or need assistance, please contact:

Sandra Paleczny, Manager
Ambulatory Care
Email: [email protected]
Phone: 519-749-4300

Outpatient Procedures

Forms

Criteria

This package provides information about the eligibility requirements for IV iron therapy and the costs and payment options. It also includes an order form for IV iron to be administered at WRHN @ Midtown.

Contact Us

If you have questions or need assistance, please contact:

Medical Day Unit
Phone: 519-749-4300, ext. 2126