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Waterloo Wellington Specialized Geriatric Services Referral Form

Please attach relevant consult notes, diagnostic reports (Labs, ECG, X-Rays) and cumulative patient profile...Physician Signature: ________________ Date:....,..,,--~--~/=20~- Fax to:...
https://www.wwhealthline.ca/pdfs/WW_SGS_ReferralForm_Fillable.pdf

Cardiodiagnostics Services Requisition Form

30-39 4% 2% 34% 12% 76% 26%...40-49 13% 3% 51% 22% 87% 55%...50-59 20% 7% 65% 33% 93% 73%...60-69...27% 14% 72% 51% 94% 86%...STEP 2. ...Determine the appropriate non-invasive risk stratification...
https://www.wwhealthline.ca/pdfs/Cardiodiagnostics-Services-Requisition-Final-June-2016.pdf