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54

TOC

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P.E.P.

For

Saskatchewan

Physicians

Phone: (306)-966-7793

FAX:

(306)-966-7673

Practice

Enhancement

Program

CME, University of Saskatchewan

Box 60001RPO Univeristy

Saskatoon, SK S7N 4J8

Referred

Specialist

Questionnaire

Q-5

5.c PRACTICE ENHANCEMENT PROGRAM

Questionnaire for Specialists Referred to by Family

Physicians

RE: Dr.

Date:

Rarely Sometimes Usually Always Does

Not

Apply

1. It is clear from the referral

letter what is expected of the

consultant.

1

2

3

4

5

2. The diagnosis by the referring

physician is appropriate to your

specialty.

1

2

3

4

5

3. The referral letter is supported

by the appropriate history, clin-

ical findings and investigations.

1

2

3

4

5

4. The diagnosis of the referring

physician appears appropriate

based on the clinical presenta-

tion and investigations carried

out prior to referral.

1

2

3

4

5

Additional Comments: