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KW4 COMMUNITY WARD
In-Home Health and Outreach Team
How To Make A Referral
Please follow the arrows below to be directed to our referral form. Primary care providers can also make a referral directly through the Telus Practice Solutions (PSS) electronic medical records (EMR)
What Happens After Referral?
After a patient has been referred, we will contact them directly to introduce ourselves, ask their permission to perform a triage based on their needs, and book them for an initial assessment.
Below are high-level steps outlining what happens after a referral is made, all the way to discharge. Patients can be with the team from 1 month up to 12 months (potentially beyond one year, depending on the needs and goals of patients).
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Referral & Triage
Triage & First Interaction With Patient
Clinical Assessment
Clinical Management
Discharge
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