Perinatal referral form
Perinatal referral form at Canuck Place Children’s Hospice
A healthcare provider looking to refer a child to Canuck Place should use the perinatal referral form.
We serve children ages 0–19. We also serve families in the prenatal stage whose fetus has been found to have a serious condition. The important factor for our program is the presence of a progressive, life-threatening condition. Progression meaning, on-going deterioration of health and/or functions. Life-threatening means the “child” is likely to not live into full adulthood (defined as early 20’s). They may die either because of a progressive disease process or because of disease effects and complications. Some children/youth are within slowly progressing phases of their conditions, while others are acutely terminal.
The referral process
If you believe a child is appropriate for our program, here are the steps to follows:
- Call the Intake Nurse at Canuck Place Children’s Hospice, 604-742-3476 or toll-free in BC at 1-877-882-2288 ext. 3476. If the referral is urgent, please call the nursing station at 604-742-3475
- The Intake Nurse will follow-up on information from the child’s physician, care provider and parents
- This information is reviewed by the Intake Team at Canuck Place
- If the child is eligible for the program, the parents/guardians are informed and advised of the programs available
All of Canuck Place’s services are available at no cost to families.