What the referral is for
It refers a patient to Dynacare’s genetic counsellors, who see patients by phone or video. Dynacare lists prenatal and fertility, neurology, oncology and hereditary cancer, hematology, pharmacogenomics and cardiovascular conditions among its areas. It is a general referral. Dynacare’s test requisitions, such as the Harmony prenatal test, are separate forms. A patient at high risk of breast cancer may also need the High Risk OBSP requisition.
Who completes it
The referring physician, midwife or nurse practitioner completes the whole form and signs it. It has no patient section, though the patient’s consent to email and their preferred language are recorded on it.
How to fill in the referral
Patient information
Name, date of birth, health coverage number, a mobile number, address, email, biological sex at birth and gender identity. Tick whether the patient consents to email and whether they need an interpreter, and name the language. Dynacare books by phone, email or text, so a wrong number delays the first contact.
Physician or healthcare provider information
Your name, phone, fax, billing number, address, email and signature, with the referral date.
Reason for referral
Tick all that apply. For a personal diagnosis, name it and say whether genetic testing confirmed it, with the gene and variant. For a variant found in a family member, give the gene and variant and attach the relative’s report. For a family history concern, name the condition.
Attachments
The form asks for clinical notes, family history, and familial variant results when known. A pedigree or relatives’ ages at diagnosis helps the counsellor most.
Common reasons it’s delayed
- A family variant named without the relative’s report attached.
- No mobile number or email, so Dynacare can’t reach the patient to book.
- A family history concern with no condition named.
- Missing interpreter language.
- Unsigned referral.
Submitting and who pays
Fax the referral and attachments to Dynacare. The patient is contacted with booking instructions, and changes to their contact details go to the email printed on the form. Dynacare says patients typically pay nothing, with coverage varying by province and insurance.