Referral of a patient to Ontario Health atHome for home and community care services.
- Completed by
- Referring physician, NP or other provider
- Issued by
- Ontario Health atHome
- Format
- Language
- English
Toronto Central Referral Form: Ontario Health atHome
Physicians and nurse practitioners in the Toronto Central region use this two-page form to refer patients to Ontario Health atHome for home and community care. It captures the reason for referral, recent falls or hospital stays, diagnoses, medications, mobility and the services requested with treatment orders. Nursing is then usually delivered at Ontario Health atHome nursing clinics rather than in the home.
Who completes it
The referring physician or nurse practitioner completes the medical information and services, gives their OHIP billing code and CPSO or CNO number, and signs; the referral source section can name another provider who initiated the referral. Page 1 also records the patient, a primary contact, and whether the POA or SDM knows about the referral.
Submitting and payment
- How to submit it
- Fax the completed form to Ontario Health atHome (Toronto Central) using the number printed on it, together with relevant documents such as a prescription or the Palliative Care Referral Form.
Good to know
- Services requested is mandatory: give the reason for each service selected plus treatment orders and start dates, whether nursing, personal care, dietitian, therapy, social work, LTC home assessment or case management.
- Nursing referrals are assessed and treated at Ontario Health atHome nursing clinics, and in-home nursing is arranged only by exception.
- Palliative referrals record the prognosis and Palliative Performance Scale score, and the form also has checkboxes for CHF, COPD and Rapid Response Nursing.
- The current version is dated June 28, 2024 (form CS-F100), a fillable PDF that asks for clear printing when completed by hand.
Get the official form
Download the current version from the source each time; forms change without notice.
Referral Form for Ontario Health atHome (Toronto Central)
Fill it with Vero
Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
How this list is checked
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.
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Frequently asked questions
What must be faxed with the Toronto Central referral?
The form tells providers to fax the referral and relevant documents together, giving a prescription and the Palliative Care Referral Form as examples. Treatment orders and start dates belong in the services requested section, along with the reason for each service selected.
Does the referral need a physician or nurse practitioner signature?
Yes. The physician or NP section asks for the referring or primary care practitioner's name, OHIP billing code and CPSO or CNO number, with a signature and date on both pages. A separate referral source block records who initiated the referral if that is someone else.