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Burlington Integrated Palliative Care Outreach Team (IPCOT) Referral Form
Complete the Burlington IPCOT referral form and fax supporting documents to: 905-631-6823
- Medical summary/ health history
- Pertinent diagnostic tests
- Current medication lists
- Pharmacy information
- Consult/ progress notes
- Other notes
File Type:
pdf
Categories:
Forms
Downloads:
196