An important objective of the Network is to improve how individuals
are referred from one facility/agency to another and to ensure that
information that is important for continuity of care is available
and communicated as the individual accesses a variety of services
across the system.
In January 1997, member organizations began using a centralized referral
system for patients and clients who have sustained an acquired brain
injury.
Applications
for Service
These forms are periodically modified. To make sure you are using the most current version of the form you require, please download it from this webpage.
Inpatient Rehab Referral Form
A common referral form is to be used for referrals to all inpatient rehab programs, including referrals to inpatient ABI rehab. The Inpatient Rehab/CCC Referral Form includes questions common to all rehab populations and population-specific inserts for different rehab populations (ABI, for example). Complete either the PDF or Word version of the application below:
Outpatient Rehab Referral Form
A common referral form is to be used for referrals to all outpatient rehab programs, including referrals to ambulatory care. Complete either the PDF or Word version of the application below:
ABI Client Community Profile
The ABI Client Community Profile is the application form to be completed when referring to a community-based ABI program (e.g. community care access centres, COTA Health, CHIRS, etc.)
 ABI Client Community Profile
ABI Service Referral Form for Physicians
The ABI Service Referral Form for Physicians is to be used by physicians in the community to access acquired brain injury services.
ABI Service Referral Form for Physicians
ABI Internal Transfer Form
The ABI Internal Transfer Form is to be used to inform the ABI Network of a move from one program to another within an organization (e.g. from inpatient to day hospital) and to inform the Network of an admission to a program in the event that the referral did not come through the Network office.
ABI Internal Transfer Form
Supporting Documents
General:
Supporting documents specifically for inpatient referrals:
Supporting documents specifically for community referrals:
Consent form for Inpatient Rehab/CCC Rehab Referral Form is available in several languages:
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