Referral Forms

Inpatient Forms

ABI Inpatient Rehab Forms

For use by: hospitals who are NOT using the RM&R electronic system and are making a referral to an inpatient ABI program.

Please complete the fax cover sheet and referral form (items 1 and 2 below), attach all the documentation requested, and fax to the Toronto ABI Network office at 416-634-8286.
For suggestions on how to complete the inpatient referral, refer to the Inpatient ABI Referral Guide – What to include in the Referral Form

    1. Fax Cover Sheet (fillable PDF)
    2. GTA Rehab Network Integrated Acute Care to Bedded/CCC Referral Form (fillable PDF)
    3. Discharge/Transfer Checklist (information to be sent with the patient to the post-acute destination on discharge)

Admission Guidelines for High-Intensity Rehabilitation

For use by: acute care hospitals who are seeking guidance on high intensity rehab admission criteria

The High Intensity Admission Guidelines provides an overview of admission criteria at the three sites that offer specialized inpatient ABI rehabilitation (Hennick Bridgepoint Hospital – Sinai Health, Toronto Rehab – University Health Network, West Park Healthcare Centre) as well as a glimpse of their available resources to manage a patient’s medical needs (e.g., bariatric equipment, dialysis, wound care, etc.).

Early Notification Form

For use by: acute care hospitals who are repatriating patients with an ABI

The ABI Early Notification Form should be completed for patients with an ABI where the patient is expected to benefit from inpatient ABI rehab, but is not yet rehab ready and repatriation to their home hospital is being planned. This form will be used by the ABI Network to track and follow up on repatriated patients. Once the patient has progressed to rehab ready status, a full inpatient ABI rehab referral must be completed by the patient’s current care team.

For any questions, please contact the Network office at 416-597-3057 or [email protected].

Repatriation Tool

For use by: acute care hospitals who are repatriating patients with an ABI

The ABI Rehab Resource Tool allows acute care hospitals to provide valuable information to the care team at the home hospital when a patient is being repatriated. The form, to be included in the acute care discharge package, will facilitate the referral/transfer to an inpatient ABI program when the patient is rehab ready

Questions? Visit our Referrals FAQ page.