{"id":3692,"date":"2022-01-19T09:58:13","date_gmt":"2022-01-19T13:58:13","guid":{"rendered":"https:\/\/chuv.umontreal.ca\/english\/?page_id=3692"},"modified":"2023-02-03T15:17:43","modified_gmt":"2023-02-03T19:17:43","slug":"case-reference-in-internal-medicine","status":"publish","type":"page","link":"https:\/\/chuv.umontreal.ca\/english\/referring-a-case-to-the-chuv\/case-reference-in-internal-medicine\/","title":{"rendered":"Case reference in internal medicine"},"content":{"rendered":"

[vc_row][vc_column width=”1\/2″][vc_message]This form is used to determine the urgency of the consultation<\/strong>.<\/p>\n

The medical record will be consulted by the team only at the time of the consultation.<\/p>\n

This form is exclusively reserved for veterinarians and staff of veterinary clinics<\/strong>. Referral requests completed directly by owners will not be processed<\/strong>.<\/p>\n

If your animal requires a referral to our specialist services, please contact your regular veterinarian. Thank you for your understanding.[\/vc_message][\/vc_column][vc_column width=”1\/2″][vc_message message_box_color=”pink”]Please note that, if the patient’s follow-up is done by you following the consultation, please check the box to that effect.<\/p>\n

Please note that in this case, client communication (treatment plan, modification\/renewal of prescription, etc.) is the responsibility of the referring veterinarian and not the CHUV medical team.<\/p>\n

However, we will be pleased to answer any questions you may have.[\/vc_message][vc_column_text]Web page of Internal Medicine Service<\/a>
\nWeb page of Internal Medicine Service <\/a>(for veterinarians only)[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column]\n

\n

<\/p>

    <\/ul><\/div>\n
    \n
    \n<\/fieldset>\n

    Reason for referral:*
    \n<\/span>\n<\/p>\n

    REFERRING VETERINARIAN\n<\/p>\n

    Veterinarian:*\n<\/p>\n

    <\/span>\n<\/p>\n

    Referring clinic:\n<\/p>\n

    <\/span>\n<\/p>\n

    Clinic phone number*:\n<\/p>\n

    <\/span>\n<\/p>\n

    Other phone number:\n<\/p>\n

    <\/span>\n<\/p>\n

    Email address*:\n<\/p>\n

    <\/span>\n<\/p>\n

    CLIENT INFORMATION\n<\/p>\n

    First name and last name*:\n<\/p>\n

    <\/span>\n<\/p>\n

    Phone number #1*:
    \n<\/span>\n<\/p>\n

    Phone number #2:
    \n<\/span>\n<\/p>\n

    Email address of the client:
    \n<\/span>\n<\/p>\n

    Other important information:\n<\/p>\n