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Out-of-Province Travel Support Application
2022-03-30
Complete this form to apply for out-of-province travel support for medical services with the Maritime Bus Program. Apply online at least 10 days prior to out-of-province travel.
Home Oxygen Program Application Form
https://www.princeedwardisland.ca/sites/default/files/forms/home_oxygen_program_application_form.pdf
2022-03-28
Complete this form if you have been diagnosed with Chronic Obstructive Pulmonary Disease (COPD) and have been prescribed oxygen. You may be eligible for coverage of expenses through the Home Oxygen Program.
Orthopaedic Intervention Clinic Referral Form
2022-03-25
Primary Care Providers and Allied Health Professionals can refer patients and clients to the Orthopaedic Intervention Clinic by completing this form and faxing it to , 902-368-6921.
Rheumatoid Arthritis Special Authorization Request Form
2022-03-24
Special authorization request form to be completed by your physician or diagnosing specialist.
Medical Assistance in Dying (MAiD) Patient Request and Consent Form
2022-02-08
This consent form is required to participate in the MAiD process. Individuals are encouraged to complete the consent form in advance of their assessment with the MAiD provider. Consent can be withdrawn or cancelled at any time. For more information, visit Medical Assistance in Dying .
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 appointment. For more...
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 Programs .
Influenza Immunization Clinic Registration Form
2021-10-06
To receive a flu vaccination, you must complete a registration form. Complete the top section of this form and bring it with you to a vaccination clinic.
Preschool Speech and Language Pathology Referral Form
2021-10-04
Referral form for your child to be seen by Speech Language Pathology.