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rac_lbp_patient_intake_form_march_2020.pdf

 High Cholesterol No Yes  Diabetes No Yes... High Blood Pressure No Yes  Kidney Disease No Yes... Stroke No Yes  Liver Disease No Yes... Heart Attack/Coronary Artery Disease No...
https://www.southeasthealthline.ca/pdfs/rac_lbp_patient_intake_form_march_2020.pdf

Telemedicine Referral Form- revised dec 2018.pdf

Nousheen Kanji...If problems faxing please contact Belleville & Quinte West CHC @ 613-962-0000 x 258 Dec 2023...161 Bridge St. ...West, Belleville ON K8P 1K2 613-962-0000 69 Catherine St Trenton K8V 5K9...
https://www.southeasthealthline.ca/pdfs/Telemedicine%20Referral%20Form-%20revised%20dec%202018.pdf