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Diabetes Referral Form
2024-04-02
Complete this form to refer or self-refer to the Provincial Diabetes Program or the Diabetes Drug Program.
Cardiac Rehab Referral Form
2022-01-19
Your physician or nurse practitioner can refer you to the Cardiac Rehab Program by submitting this referral form. An exercise stress test must be sent in with your referral. If you meet the inclusion criteria for the program, you will be contacted for an assessment...
Pulmonary Rehab Referral Form
2022-01-19
Your physician or nurse practitioner can refer you to the Pulmonary Rehab Program by submitting this referral form. If you meet the inclusion criteria for the program, you will be contacted for an assessment appointment.
For more information, visit the Cardiac and Pulmonary Rehab...
Insulin Pump Program: Client / Family Contribution Assessment and Release of Information Form
2021-01-28
Complete this form to register for the Insulin Pump Program.
Gender Confirming Surgery Prior Approval Request Form
2019-04-17
Gender confirming surgery is insured under PEI Medicare when prior authorization has been obtained from Health PEI. Your family physician or nurse practitioner will need to complete this form and provide the necessary attachments to Health PEI's Out-of-Province Coordinator.
Blood Glucose Record - Travelling Across Time Zones
2016-04-21
Use this to record your blood glucose levels while you are travelling across time zones.
Blood Glucose Record - 24 Hour
2016-04-21
Use this to record your blood glucose levels over a 24 hour period.