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Displaying 1 - 10 of 73 records for "forms"
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Glucose Sensor Program Renewal Form
2024-04-25
This form is to renew your enrolment in the Glucose Sensor Program.
To renew your benefits for both the Glucose Sensor Program and the Insulin Pump Program together, complete the Insulin Pump Program and Glucose Sensor Program Renewal Form instead.
Child Audiology Referral Form
2019-01-15
Complete this form to request audiology services for children.
Diabetes Referral Form
2024-04-02
Complete this form to refer or self-refer to the Provincial Diabetes Program or the Diabetes Drug 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.
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...
Formulaire d'objectifs des soins
2016-11-23
The Goals of Care form is used by your health care provider after speaking with you and your substitute decision maker. These instructions that will guide your health care team about the general focus of your care and where you might want that care. Your health care provider will write your Goals...