Coordinated Service Planning Referral Form

The personal data collected on the on-line Coordinated Service Planning (CSP) Referral Form is used to verify our current client records and to determine eligibility for admission.

Once the form is received, the Access Team will follow up to complete a needs assessment and determine eligibility for Coordinated Service Planning. This form will be part of the child or youth's medical record, and is confidential.

Please note: If you are submitting this referral on behalf of a family, child or youth please ensure the family is aware and consents to the referral. Consent will be reviewed with family at time of intake.

Please complete one form per child.

Referral Source
Child/Youth Information
Legal Guardian
Legal Guardian
Why is Coordinated Service Planning (CSP) being requested
These documents are confidential and are for the sole use of the intended recipient. Any unauthorized use, disclosure or distribution is prohibited. All SickKids lab results contained in this medical record were generated by a clinically accredited laboratory. The laboratory is not a forensically accredited laboratory. Testing by the laboratory is carried out for clinical use and results are not intended for forensic use. If you mistakenly receive these documents please destroy and contact the sender immediately. This page was printed on Saturday 02 December 2023 at 2:42:06 AM.