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Emergency Information 
Endocrinology Central Access and Triage   at
Calgary Zone and Area
Central Access Healthcare Service
Specialty: Endocrinology
Connect Care Department: CALGARY ZONE ENDOCRINOLOGY CAT
Estimated time to routine appointment: Not Available
Alberta Health Services - Calgary Zone
CENTRAL ACCESS SERVICES
This central access referral service provides a single point of entry for individuals who need to see an endocrinologist in the Calgary Zone. Provides a referral service for doctors, emergency departments, and urgent care centres that need to refer people to see an endocrinologist.
This central access referral service provides a single point of entry for individuals who need to see an endocrinologist in the Calgary Zone. Provides a referral service for doctors, emergency departments, and urgent care centres that need to refer people to see an endocrinologist.
ELIGIBILITY REQUIREMENTS
Patients who could benefit from seeing an endocrinologist.
Patients who could benefit from seeing an endocrinologist.
Referral instructions for primary care, community care, private
providers etc. who do not send referrals via Connect Care.
REFERRAL PROCESS - FOR NON-CONNECT CARE USERS
Complete the appropriate referral form and send it to the service using the contact information in this profile. Ensure referring physician's Prac ID is listed on the referral.

For URGENT referral (i.e. any red flags) please call:
• Specialist Link 403-910-2551 OR 1-844-962-5465 (Mon-Fri 0900-1700).
• Endocrinologist on call 403-944-1110 (Mon-Fri 1700-0900 and weekends).

Fax Diabetes in Pregnancy referrals to the Diabetes in Pregnancy Clinic:
• Foothills Medical Centre 403-776-3836
• Sunridge Medical Gallery 403-776-3837
• Rockyview General Hospital 403-776-3838
• South Health Campus 403-776-3837
Complete the appropriate referral form and send it to the service using the contact information in this profile. Ensure referring physician's Prac ID is listed on the referral.

For URGENT referral (i.e. any red flags) please call:
• Specialist Link 403-910-2551 OR 1-844-962-5465 (Mon-Fri 0900-1700).
• Endocrinologist on call 403-944-1110 (Mon-Fri 1700-0900 and weekends).

Fax Diabetes in Pregnancy referrals to the Diabetes in Pregnancy Clinic:
• Foothills Medical Centre 403-776-3836
• Sunridge Medical Gallery 403-776-3837
• Rockyview General Hospital 403-776-3838
• South Health Campus 403-776-3837
REFERRAL PROCESS - FOR CONNECT CARE USERS
Send an Internal Referral using the Ambulatory Referral Order to Endocrinology, type CALGARY ZONE ENDOCRINOLOGY CAT in the “To Department” section and complete order.

For URGENT referral (i.e. any red flags) please call:
• Specialist Link 403-910-2551 OR 1-844-962-5465 (Mon-Fri 0900-1700).
• Endocrinologist on call 403-944-1110 (Mon-Fri 1700-0900 and weekends).

For Diabetes in Pregnancy referrals, click a location link for Connect Care information:
• Foothills Medical Centre 
• Sunridge Medical Gallery 
• Rockyview General Hospital 
• South Health Campus
Send an Internal Referral using the Ambulatory Referral Order to Endocrinology, type CALGARY ZONE ENDOCRINOLOGY CAT in the “To Department” section and complete order.

For URGENT referral (i.e. any red flags) please call:
• Specialist Link 403-910-2551 OR 1-844-962-5465 (Mon-Fri 0900-1700).
• Endocrinologist on call 403-944-1110 (Mon-Fri 1700-0900 and weekends).

For Diabetes in Pregnancy referrals, click a location link for Connect Care information:
• Foothills Medical Centre 
• Sunridge Medical Gallery 
• Rockyview General Hospital 
• South Health Campus
COMMUNICATION PROCESS
  • Referral receipt to referring source within 7 days.
  • Acceptance via appointment details or wait list status letter to referring source and patient within 14 days.
  • Wait list status update every 90 days.
  • Appointment outcome to referral source within 30 days.
ADDITIONAL SERVICE DETAILS
Please refer to UofC Department of Medicine website for additional details for the Endocrinology Division.

All referrals must have:
  • Current medication list
  • Current description, onset, and duration of symptoms
  • Past medical history
Please review the reasons for referral below, if the reason is not specified your referral may be declined.
If your referral is declined and you have further questions, please call Specialist Link to speak to an Endocrinologist.
Please refer to UofC Department of Medicine website for additional details for the Endocrinology Division.

All referrals must have:
  • Current medication list
  • Current description, onset, and duration of symptoms
  • Past medical history
Please review the reasons for referral below, if the reason is not specified your referral may be declined.
If your referral is declined and you have further questions, please call Specialist Link to speak to an Endocrinologist.
 
CENTRAL ACCESS REFERRAL PHONE
403-955-8633
CENTRAL ACCESS REFERRAL FAX
403-476-9626
REFERRAL FORMS
PATHWAYS
CENTRAL ACCESS LINKED SERVICES
AFFILIATED SERVICES
LINKED SPECIALISTS
CLICK + TO VIEW REFERRAL GUIDELINES
+-
Routine Reason for Referral
Access Targets convey the clinically appropriate timeframe patients should be seen within, by reason for referral and priority level.
Access Target
Required Information/Investigations
Investigation Timing
Additional Details
+-
Adrenal insufficiency
4 Weeks
AM Cortisol
 
N/A
Suggested:
  • Creatinine measurement, serum
  • Electrolytes measurement, serum
 
Within 3 months
Urgent: If any of the red flags below are present, please label referral as urgent and call Specialist LINK.
Red flags: 
  • Hypotension
  • Abdominal Pain
  •  N & V
  • Decreased LOC
Emergent: For Severe Adrenal Insufficiency, direct patients to Emergency department or call RAAPID South: 1-800-661-1700 or 403-944-4486.
  • Severe Adrenal Insufficiency:
    • hypotension
    • abdominal pain
    • nausea
    • vomiting
    • decreased level of consciousness
Access targets:
  • Urgent: 1 week
  • Routine: 4 weeks
+-
Adrenal mass
4 Months
Any relevant diagnostic imaging
 
Within 3 months
Urgent: If any of the red flags are present, call Specialist LINK to help with urgency or label referral as URGENT
Red flags: Symptoms of hormone excess (eg. Cushing's , Severe HTN with a low K+, or labile HTN suggestive of pheochromocytoma) or rapid growth

Access targets:
  • Urgent: 2 weeks
  • Routine: 4 months
+-
Amenorrhea
6 Months
Pregnancy test
 
Within 1 month
Helpful Investigations:
  • TSH
  • Prolactin
  • FSH
  • LH
  • Estradiol
  • Free Androgen Index
  • Progesterone Challenge
 
N/A
+-
Cushing's disease
6 Months
Biochemical confirmation of excess (eg. 24hour urine free cortisol, post-1 mg dexamethasone suppression test)
 
Within 3 months
Include history of steroid injection
 
Within 3 years
Medication List (dose, frequency, route) - please include any steroids or hormonal contraception
 
Current
Helpful investigations:
  • BP
  • Lipid Profile
  • HgbA1c
  • Serum Cr
 
N/A
Urgent: If any of the red flags are present, call Specialist LINK to help with urgency or label referral as URGENT

Red Flags: rapid progression of symptoms of hirsutism, muscle wasting, weight loss or weight gain, new onset DM or HTN. If advice is needed to determine urgency, please call Specialist Link.

Access targets:
  • Urgent: 4 weeks
  • Semi-urgent: 12 weeks
  • Routine 6 months
+-
Decreased testosterone level
6 Months
Medication List (dose, frequency, route) including any exogenous testosterone use
 
Current
Biochemicaly confirmation of low testosterone level (preferably a free androgen index) measured before 10 am
 
Within 3 months
+-
Diabetes insipidus
6 Months
Biochemicaly confirmation of daily hypotonic urine output >2.5L
 
Within 3 months
  • Electrolytes (fasting)
  • Spot serum & urine osmolality
 
Within 3 months
Provide confirmation of increased urine volume (>2.5L) and decreased urine osmolality (spot <400) or referral may not be accepted.

Urgent: If any of the red flags are present, call Specialist LINK to help with urgency or label referral as URGENT
Red Flags: Hypotension, Na >150 mmol/L, recent pituitary surgery.

Access targets:
  • Urgent: 2 weeks
  • Routine: 6 months





+-
Diabetes mellitus
12 Months
  • Medication List (dose, frequency, route)
  • Past medical history
  • Please document any hypoglycemia
 
Current
Helpful investigations:
  • Electrolytes
  • A1c
  • lipid profile
  • Urine microalbumin to Cr ratio
 
N/A
Urgent: Please note that for urgent consults, patients may be seen sooner by DM educator with physician support.

Access Targets:
  • Urgent: 3 months
  • Routine: 12 months
+-
Disorder of lipid metabolism
6 Months
Recent lipid profile
 
Within 6 months
Helpful investigations:
  • Lipoprotein (a)
  • A1c
  • TSH
 
N/A
+-
Galactorrhea not associated with childbirth
6 Months
Medication List (dose, frequency, route) - please make special note of any use of:
  • cannabis
  • motility drugs
  • estrogen
  • anti-depression or anti - anxiety medications
  • anti - seizure medications
 
Current
Biochemical investigations: Prolactin
 
Within 3 months
+-
Gestational diabetes
10 Days
This referral must be sent to the Diabetes in Pregnancy program
 
N/A
Gestational diabetes diagnosis as per the 2018 Diabetes Canada Preferred Approach
 
N/A
This reason for referral must be sent to the Diabetes in Pregnancy program:
Semi Urgent:
  • 32-35 weeks gestation
  • 50-gram screen >13.0mmol/L
  • Fasting glucose on OGTT ≥ to 6.0mmol/L or 2-hour glucose on OGTT ≥12.0mmol/L
  • A1C in pregnancy 6.0-6.4% with a current ferritin level (within the last 3 months) ≥30 ug/L.
Access Targets:
  • Semi-Urgent: 5 business days
  • Routine: 10 business days
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Gynecomastia
6 Months
AM Testosterone
 
Within 3 months
Prolactin
 
Within 3 months
Helpful investigations:
  • HCG
  • AFP
  • liver enzymes
  • creatinine
  • US breast or mammogram
 
N/A
+-
Hereditary disorder of endocrine system
12 Months
Genetic/Syndromic diagnosis in patient or family member
 
N/A
+-
Hirsutism
12 Months
  • AM Free androgen index
  • Serum electrolytes
 
Within 6 months
Urgent: If any of the red flags are present, call Specialist LINK to help with urgency and label referral as URGENT

Red Flags: rapid progression of symptoms of hirsutism, Virilization, muscle wasting, weight loss or weight gain, new onset DM or HTN. If advice is needed to determine urgency, please call Specialist Link.

Access Targets:
  • Urgent: 4 weeks
  • Routine: 12 months
+-
Hypercalcemia
12 Months
Calcium
 
Within 3 months
Helpful investigations:
  • PTH
  • Phosphate
  • Albumin
  • Bone Density within last 3 years
  • Renal Ultrasound
 
N/A
Urgent: If any of the red flags are present, call Specialist LINK to help with urgency and label referral as URGENT
Red Flags: Confusion, Calcium >3.0 mmol/L, GFR < 30

Emergent: For Severe Hypercalcemia direct patients to Emergency department or call RAAPID South: 1-800-661-1700 or 403-944-4486.

Access Targets:
  • Urgent: 4 weeks
  • Semi-urgent: 12 weeks
  • Routine: 12 months
+-
Hyperparathyroidism
12 Months
Calcium
 
Within 3 months
Helpful investigations:
  • PTH
  • Phosphate
  • Albumin
  • Bone Density within last 3 years
  • Renal Ultrasound
 
N/A
Urgent: If any of the red flags are present, call Specialist LINK to help with urgency and label referral as URGENT
Red Flags: Confusion, Calcium >3.0 mmol/L, GFR < 30

Access targets:
  • Urgent: 4 weeks
  • Routine: 12 months
+-
Hypertension
6 Months
Investigations if suspect Endocrine cause:
  • 24hr urine sodium
  • Electrolyte Panel
  • Creatinine
  • Serum Aldosterone to Renin Ratio
  • 24hr urine Metanephrines
 
Within 6 months
The Endocrine Hypertension Clinic accepts referrals for:
1. Any patient where the reason for hypertension is proven or likely to be primary aldosteronism, Cushing syndrome, or pheochromocytoma
2. Any patient with hypertension that is uncontrolled despite 3 or more medications
3. Any patient whose hypertension is accompanied by low potassium (including diuretic-induced) or a known adrenal mass
4. Any patient with hypertension and abnormal endocrine biochemical test results (aldosterone/renin ratio, cortisol, metanephrine, normetanephrine)
5. Any patient under the age of 30, requiring investigation for secondary hypertension

The following referrals will be triaged by General Endocrinology:
1. Adrenal mass without hypertension or hypokalemia
2. Referrals where the primary reason for consultation is not related to hypertension (e.g., referral for diabetes care in a patient who also has coexisting hypertension)
3. Referrals for hypotension

The following referrals will be declined:
1. Any patient where the reason for hypertension is proven or likely to be renovascular disease (please redirect to nephrology)
2. Any patient with advanced chronic kidney disease with an estimated GFR of 20 or less (please redirect to nephrology)
3. Dysautonomia and POTS (please redirect to Calgary Autonomic Investigation and Management Clinic)
4. Request for help or advice related to general antihypertensive medication intolerances (please redirect to general internal medicine)
+-
Hyperthyroidism
6 Months
Biochemical investigations:
  • TSH
  • Free T4
  • TRAB (if suspicious of Grave's disease)
 
Within 1 month
Pregnancy test (if female)
 
Within 1 month
If any of the following symptoms, include details in medical history:
  • weight loss
  • tremor
  • palpitations
  • muscle weakness
  • shortness of breath
 
N/A
If nodule felt clinically: Thyroid Ultrasound
 
N/A
Urgent: If any of the red flags are present, call Specialist LINK to help with urgency and label referral as URGENT
Red Flags: Unstable or evidence of CHF, arrhythmia, chest pain

Emergent: Hyperthyroidism with red flags, direct patients to Emergency department or call RAAPID South: 1-800-661-1700 or 403-944-4486.

Access Targets:
  • Urgent: 4 weeks
  • Semi-Urgent: 12 weeks
  • Routine: 6 months
+-
Hypertriglyceridemia
6 Months
Lipid Profile
 
Within 1 month
Helpful investigations:
  • TSH
  • ALT
  • Lipase
  • HgBA1c
 
N/A
Emergent: For Hypertriglyceridemia, direct patients to Emergency department or call RAAPID South: 1-800-661-1700 or 403-944-4486.

Red flags:
  • Severe epigastric discomfort
  • nausea
  • emesis to suggest pancreatitis
Access Targets:
  • Urgent: 8 weeks
  • Routine: 6 months
+-
Hypocalcemia
6 Months
Calcium
 
Within 1 month
Helpful investigations:
  • PTH
  • Phosphate
  • Albumin
 
N/A
Red Flags: tetany, bronchospasm, Calcium <1.7 mmol/L,
Urgent: If any of the red flags are present, call Specialist LINK to help with urgency or label referral as URGENT
Access Targets:
  • Urgent: 4 weeks
  • Routine: 6 months
+-
Hypoglycemia
6 Months
Medication List (dose, frequency, route); please include all oral or injectable glucose lowering medications or steroids
 
Current
Past medical history without a diagnosis of pre-existing diabetes
 
Current
Description, onset and duration of symptoms, specifically Whipple's triad
 
Current
Documented hypoglycemia below 4 mmol/L on a venous blood
 
Current
Helpful investigations:
  • HgbA1c
  • fasting glucose
  • AM cortisol
  • ALT
  • Cr
 
N/A
Emergent: Confusion, decrease level of consciousness or seizure in context of hypoglycemia; direct patients to Emergency department or call RAAPID South: 1-800-661-1700 or 403-944-4486.

Access Targets:
  • Urgent: 4 weeks
  • Routine: 6 months
+-
Hypogonadism
12 Months
Pregnancy test (if female)
 
Within 1 month
AM testosterone or free androgen (for male) below reference range
 
Within 1 month
Helpful investigations:
  • TSH
  • Prolactin
  • FSH
  • LH
  • Estradiol
  • Progesterone Challenge (if female)
  • BHCG
 
N/A
+-
Hypothyroidism
12 Months
Please indicate if patient pregnant*
 
Current
Documented TSH above the reference range
 
Within 12 months
If patient has secondary hypothyroidism, a free T4 is required
 
Within 12 months
*If patient is pregnant, please follow specialist link pathway for "assessing thyroid function related to pregnancy"
Access Targets:
  • Urgent: 4 weeks
  • Routine: 12 months
+-
Malignant tumor of thyroid gland
6 Months
Pathology report
 
Current
OR Report
 
Current
If the OR or pathlology reports are not available, the assignment of risk and appointment booking time frame will be low risk/routine by default.
Access Targets:
  • Urgent: 6 weeks
  • Semi-Urgent: 12 weeks
  • Routine: 6 months
+-
Osteoporosis
12 Months
Refer to Dr. David Hanley Osteoporosis Centre for specific guidelines.
 
N/A
Access Targets:
  • Urgent: 3 months
  • Routine: 12 months
+-
Pituitary mass
3 Months
MRI or CT scan of brain or pituitary lesion
 
Within 12 months
Helpful investigations:
  • Prolactin
  • IGF-1
  • Free T4
  • AM cortisol (if >1 cm)
 
N/A
Urgent: If any form of noted vision loss or severe compression of chiasm, please label referral as urgent and call Specialist LINK to speak to Endocrinologist

Red Flags: Sudden or rapid growth of pituitary lesion, increased cranial pressure, sudden and severe headache, sudden vision loss

Emergent: For pituitary macroadenoma (>1.0 cm) with red flags and direct them to Emergency department or call RAAPID South: 1-800-661-1700 or 403-944-4486.

Access Targets:
  • Urgent: 2 weeks
  • Semi-urgent: 3 months
  • Routine: 3 months
+-
Polycystic ovary syndrome
12 Months
Pregnancy test
 
Within 1 month
17 hydroxyprogesterone
 
Available on Netcare/Connect Care
Helpful investigations:
  • TSH
  • Prolactin
  • FSH
  • LH
  • Estradiol
  • Progesterone Challenge
  • Free Androgen Index
  • Lipid profile
  • A1c
 
N/A
Urgent: If any of the red flags are present, call Specialist LINK to help with urgency and label referral as URGENT

Red Flags: rapid progression of symptoms of hirsutism, Virilization, muscle wasting, weight loss or weight gain, new onset DM or HTN. If advice is needed to determine urgency, please call Specialist Link.
+-
Pregnancy and type 1 diabetes mellitus
N/A
 
N/A
Urgent:
1. Recent treatment for diabetic ketoacidosis (DKA) or severe hypoglycemia (pregnant or non-pregnant).
2. Suspicious diagnosis of type 1 or type 2 diabetes identified during the pregnancy.
Example:
  • FBG ≥ 7.0 mmol/L
  • HbA1c ≥ 6.5%
3. Any known type 1 or type 2 diabetes and pregnant or confirmed diagnosis of MODY in an individual who is pregnant and has not received care in DIP this pregnancy.
Access Targets:
  • Urgent: 3 business days
Diabetes in Pregnancy Clinics:
+-
Pregnancy and type 2 diabetes mellitus
Medication List (dose, frequency, route)
 
Current
Past medical history
 
Current
Description, onset and duration of symptoms
 
Current
Urgent:
1. Recent treatment for diabetic ketoacidosis (DKA) or severe hypoglycemia (pregnant or non-pregnant).
2. Suspicious diagnosis of type 1 or type 2 diabetes identified during the pregnancy.
Example:
  • FBG ≥ 7.0 mmol/L
  • HbA1c ≥ 6.5%
3. Any known type 1 or type 2 diabetes and pregnant or confirmed diagnosis of MODY in an individual who is pregnant and has not received care in DIP this pregnancy.
Access Targets:
  • Urgent: 3 business days
Diabetes in Pregnancy Clinics:
+-
Referral to diabetes preconception counseling clinic
< 1 Month
N/A
 
N/A
+-
Thyroid nodule
12 Months
Medication List (dose, frequency, route)
 
Current
Past medical history
 
Current
Description, onset and duration of symptoms
 
Current
US of thyroid, including nodule risk stratification (TIRADS or ATA)
 
Within 6 months
TSH
 
Within 6 months
Helpful investigations:
  • Thyroid Tc99 scan if TSH <0.2, FNA ordered
 
N/A
Semi-urgent: high suspicion features on US (TR5), >4 cm high risk nodule, suspicious lymph nodes, suspected extrathyroidal extension on US

Red Flags: hoarseness of voice, dysphagia, stridor, or rapid growth (on the order of weeks)
If Red flags are present: refer to surgery

Yellow Flags: high suspicion features on US (TR5), >4 cm high risk nodule, suspicious lymph nodes, suspected extrathyroidal extension on US
For more information, please see the Primary Care Pathway: Thyroid Nodules

Access Targets:
  • Urgent: 4 weeks
  • Semi-Urgent: 3 months
  • Routine: 12 months
+-
Transgender related consultation
< 12 Months
Outline of question being asked
 
Current
Labs:
  • Estradiol
  • Free testosterone level
  • LH
  • CBC
  • Creatinine
  • Electrolytes
  • ALT
  • TSH
  • Hemoglobin A1c
  • Lipid panel
  • Apolipoprotein B100
 
N/A
Urgent: Examples - GAHT start with high level of gender dysphoria/difficulty functioning, possible GAHT complication, sex hormone sensitive cancer, complex decompensated medical condition query what to do with GAHT.
Immediate advice: Trans Health Specialist Link
For more details, please see Provincial Adult Gender-Affirming Care Primary Care Clinical Pathway
Access Targets:
  • Urgent: within 3 months
  • Semi-Urgent: 3-6 months
  • Routine: 6-12 months
+-
Type 1 diabetes mellitus
Helpful investigations:
  • A1c
  • Lipid Profile (<1year)
  • Urine Microalbumin to Creatine Ratio
  • Creatinine
  • CBC
  • ALT
 
N/A
Emergent: For Type 1 Diabetes Mellitus, direct patients to Emergency department or call RAAPID South: 1-800-661-1700 or 403-944-4486.

Type 1 Diabetes Mellitus: 
  • Newly diagnosed,
  • evidence of Diabetic Ketoacidosis
  • polyuria
  • polydipsia
  • abdominal pain and nausea
  • anorexia
  • vomiting
  • weight loss
  • decreased level of consciousness

+-
Urgent Reason for Referral
Access Targets convey the clinically appropriate timeframe patients should be seen within, by reason for referral and priority level.
Access Target
Required Information/Investigations
Investigation Timing
Additional Details
+-
Adrenal insufficiency
1 Week
AM Cortisol
 
Within 1 month
Suggested:
  • Creatinine measurement, serum
  • Electrolytes measurement, serum
 
Within 3 months
Urgent: If any of the red flags below are present, please label referral as urgent and call Specialist LINK.
Red flags: 
  • Hypotension
  • Abdominal Pain
  •  N & V
  • Decreased LOC
Emergent: For Severe Adrenal Insufficiency, direct patients to Emergency department or call RAAPID South: 1-800-661-1700 or 403-944-4486.
  • Severe Adrenal Insufficiency:
    • hypotension
    • abdominal pain
    • nausea
    • vomiting
    • decreased level of consciousness
Access targets:
  • Urgent: 1 week
  • Routine: 4 weeks
+-
Adrenal mass
2 Weeks
Any relevant diagnostic imaging
 
Within 3 months
Urgent: If any of the red flags are present, call Specialist LINK to help with urgency or label referral as URGENT
Red flags: Symptoms of hormone excess (eg. Cushing's , Severe HTN with a low K+, or labile HTN suggestive of pheochromocytoma) or rapid growth

Access targets:
  • Urgent: 2 weeks
  • Routine: 4 months
+-
Cushing's disease
4 Weeks
Biochemical confirmation of excess (e.g. 24hour urine free cortisol, post-1 mg dexamethasone suppression test)
 
Within 3 months
Include history of steroid injection
 
Within 3 years
Medication List (dose, frequency, route) - please include any steroids or hormonal contraception
 
Current
Helpful investigations:
  • BP
  • Lipid Profile
  • HgbA1c
  • Serum Cr
 
N/A
Urgent: If any of the red flags are present, call Specialist LINK to help with urgency or label referral as URGENT

Red Flags: rapid progression of symptoms of hirsutism, muscle wasting, weight loss or weight gain, new onset DM or HTN. If advice is needed to determine urgency, please call Specialist Link.

Access targets:
  • Urgent: 4 weeks
  • Semi-urgent: 12 weeks
  • Routine 6 months
+-
Diabetes insipidus
2 Weeks
Biochemicaly confirmation of low testosterone level (preferably a free androgen index) measured before 10 am
 
Within 3 months
  • Electrolytes (fasting)
  • Spot serum & urine osmolality
 
Within 3 months
Provide confirmation of increased urine volume (>2.5L) and decreased urine osmolality (spot <400) or referral may not be accepted.

Urgent: If any of the red flags are present, call Specialist LINK to help with urgency or label referral as URGENT
Red Flags: Hypotension, Na >150 mmol/L, recent pituitary surgery.

Access targets:
  • Urgent: 2 weeks
  • Routine: 6 months

+-
Diabetes mellitus
3 Months
  • Medication List (dose, frequency, route)
  • Past medical history
  • Please document any hypoglycemia
 
Current
Helpful investigations:
  • Electrolytes
  • A1c
  • lipid profile
  • Urine microalbumin to Cr ratio
 
N/A
Urgent: Please note that for urgent consults, patients may be seen sooner by DM educator with physician support.
Access Targets:
  • Urgent: 3 months
  • Routine: 12 months
+-
Gestational diabetes
5 Days
This referral must be sent to the Diabetes in Pregnancy Program
 
Current
This reason for referral must be sent to the Diabetes in Pregnancy program:
Semi Urgent:
  • 32-35 weeks gestation
  • 50-gram screen >13.0mmol/L
  • Fasting glucose on OGTT ≥ to 6.0mmol/L or 2-hour glucose on OGTT ≥12.0mmol/L
  • A1C in pregnancy 6.0-6.4% with a current ferritin level (within the last 3 months) ≥30 ug/L.
Access Targets:
  • Semi-Urgent: 5 business days
  • Routine: 10 business days
+-
Hirsutism
4 Weeks
  • AM Free androgen index
  • Serum electrolytes
 
Within 6 months
Urgent: If any of the red flags are present, call Specialist LINK to help with urgency and label referral as URGENT

Red Flags: rapid progression of symptoms of hirsutism, Virilization, muscle wasting, weight loss or weight gain, new onset DM or HTN. If advice is needed to determine urgency, please call Specialist Link.

Access Targets:
  • Urgent: 4 weeks
  • Routine: 12 months
+-
Hypercalcemia
4 Weeks
Calcium
 
Within 3 months
Helpful investigations:
  • PTH
  • Phosphate
  • Albumin
  • Bone Density within last 3 years
  • Renal Ultrasound
 
N/A
Urgent: If any of the red flags are present, call Specialist LINK to help with urgency and label referral as URGENT
Red Flags: Confusion, Calcium >3.0 mmol/L, GFR < 30

Emergent: For Severe Hypercalcemia direct patients to Emergency department or call RAAPID South: 1-800-661-1700 or 403-944-4486.

Access Targets:
  • Urgent: 4 weeks
  • Semi-urgent: 12 weeks
  • Routine: 12 months
+-
Hyperparathyroidism
4 Weeks
Calcium
 
Within 3 months
Helpful investigations:
  • PTH
  • Phosphate
  • Albumin
  • Bone Density within last 3 years
  • Renal Ultrasound
 
N/A
Red Flags: Confusion, Calcium >3.0 mmol/L, GFR < 30
Urgent: If any of the red flags are present, call Specialist LINK to help with urgency and label referral as URGENT
Access Targets:
  • Urgent: 4 weeks
  • Routine: 12 months
+-
Hyperthyroidism
4 Weeks
Biochemical investigations:
  • TSH
  • Free T4
  • TRAB (if suspicious of Grave's disease)
 
Within 1 month
Pregnancy test (if female)
 
Within 1 month
If any of the following symptoms, include details in medical history:
  • weight loss
  • tremor
  • palpitations
  • muscle weakness
  • shortness of breath
 
N/A
If nodule felt clinically: Thyroid Ultrasound
 
N/A
Urgent: If any of the red flags are present, call Specialist LINK to help with urgency and label referral as URGENT
Red Flags: Unstable or evidence of CHF, arrhythmia, chest pain

Emergent: Hyperthyroidism with red flags, direct patients to Emergency department or call RAAPID South: 1-800-661-1700 or 403-944-4486.

Access Targets:
  • Urgent: 4 weeks
  • Semi-Urgent: 12 weeks
  • Routine: 6 months
+-
Hypertriglyceridemia
8 Weeks
Lipid profile
 
Within 1 month
Helpful investigations:
  • TSH
  • ALT
  • Lipase
  • HgBA1c
 
N/A
Urgent: If any of the red flags below are present, please label referral as urgent and call Specialist LINK.

Emergent: For Hypertriglyceridemia, direct patients to Emergency department or call RAAPID South: 1-800-661-1700 or 403-944-4486.

Red flag:
  • Severe epigastric discomfort
  • nausea
  • emesis to suggest pancreatitis
Access Targets:
  • Urgent: 8 weeks
  • Routine: 6 months
+-
Hypocalcemia
4 Weeks
Calcium
 
Within 1 month
Helpful investigations:
  • PTH
  • Phosphate
  • Albumin
 
N/A
Urgent: If any of the red flags are present, call Specialist LINK to help with urgency or label referral as URGENT

Red Flags: tetany, bronchospasm, Calcium <1.7 mmol/L,

Access Targets:
  • Urgent: 4 weeks
  • Routine: 6 months
+-
Hypoglycemia
4 Weeks
Medication List (dose, frequency, route); please include all oral or injectable glucose lowering medications or steroids
 
Current
Past medical history without a diagnosis of pre-existing diabetes
 
Current
Description, onset and duration of symptoms, specifically Whipple's triad
 
Current
Documented hypoglycemia below 4 mmol/L on a venous blood
 
Current
Helpful investigations:
  • HgbA1c
  • fasting glucose
  • AM cortisol
  • ALT
  • Cr
 
N/A
Access Targets:
  • Urgent: 4 weeks
  • Routine: 6 months
+-
Hypothyroidism
4 Weeks
Please indicate if patient pregnant*
 
Current
Documented TSH above the reference range
 
Within 12 months
If patient has secondary hypothyroidism, a free T4 is required
 
Within 12 months
*If patient is pregnant, please follow specialist link pathway for "assessing thyroid function related to pregnancy"

Access Targets:
  • Urgent: 4 weeks
  • Routine: 12 months
+-
Malignant tumor of thyroid gland
6 Weeks
Pathology report
 
Current
OR report
 
Current
If the OR or pathlology reports are not available, the assignment of risk and appointment booking time frame will be low risk/routine by default.
Access Targets:
  • Urgent: 6 weeks
  • Semi-Urgent: 12 weeks
  • Routine: 6 months
+-
Osteoporosis
3 Months
Refer to Dr. David Hanley Osteoporosis Centre for specific guidelines.
 
N/A
Access Targets:
  • Urgent: 3 months
  • Routine: 12 months
+-
Pituitary mass
2 Weeks
MRI or CT scan of brain or pituitary lesion
 
Within 12 months
Helpful investigations:
  • Prolactin
  • IGF-1
  • Free T4
  • AM cortisol (if >1 cm)
 
N/A
Urgent: If any form of noted vision loss or severe compression of chiasm, please label referral as urgent and call Specialist LINK to speak to Endocrinologist

Red Flags: Sudden or rapid growth of pituitary lesion, increased cranial pressure, sudden and severe headache, sudden vision loss

Emergent: For pituitary macroadenoma (>1.0 cm) with red flags and direct them to Emergency department or call RAAPID South: 1-800-661-1700 or 403-944-4486.

Access Targets:
  • Urgent: 2 weeks
  • Semi-urgent: 3 months
  • Routine: 3 months
+-
Pregnancy and type 1 diabetes mellitus
3 Days
N/A
 
N/A
Urgent:
  1. Recent treatment for diabetic ketoacidosis (DKA) or severe hypoglycemia (pregnant or non-pregnant).
  2. Suspicious diagnosis of type 1 or type 2 diabetes identified during the pregnancy. Example:
  • FBG ≥ 7.0 mmol/L
  • HbA1c ≥ 6.5%
   3. Any known type 1 or type 2 diabetes and pregnant or confirmed diagnosis of MODY in an individual who is pregnant and has not received care in DIP this pregnancy.

Access Targets:
  • Urgent: 3 business days
Diabetes in Pregnancy Clinics:
+-
Pregnancy and type 2 diabetes mellitus
3 Days
Medication List (dose, frequency, route)
 
Current
Past medical history
 
Current
Description, onset and duration of symptoms
 
Current
Urgent:
1. Recent treatment for diabetic ketoacidosis (DKA) or severe hypoglycemia (pregnant or non-pregnant).
2. Suspicious diagnosis of type 1 or type 2 diabetes identified during the pregnancy.
Example:
  • FBG ≥ 7.0 mmol/L
  • HbA1c ≥ 6.5%
3. Any known type 1 or type 2 diabetes and pregnant or confirmed diagnosis of MODY in an individual who is pregnant and has not received care in DIP this pregnancy.
Access Targets:
  • Urgent: 3 business days
Diabetes in Pregnancy Clinics:
+-
Thyroid nodule
4 Weeks
Medication List (dose, frequency, route)
 
Current
Past medical history
 
Current
Description, onset and duration of symptoms
 
Current
US of thyroid, including nodule risk stratification (TIRADS or ATA)
 
Within 6 months
TSH
 
Within 6 months
Helpful investigations:
  • Thyroid Tc99 scan if TSH <0.2, FNA ordered
 
N/A
Semi-urgent: high suspicion features on US (TR5), >4 cm high risk nodule, suspicious lymph nodes, suspected extrathyroidal extension on US

Red Flags: hoarseness of voice, dysphagia, stridor, or rapid growth (on the order of weeks)
If Red flags are present: refer to surgery

Yellow Flags: high suspicion features on US (TR5), >4 cm high risk nodule, suspicious lymph nodes, suspected extrathyroidal extension on US
For more information, please see the Primary Care Pathway: Thyroid Nodules

Access Targets:
  • Urgent: 4 weeks
  • Semi-Urgent: 3 months
  • Routine: 12 months
+-
Transgender related consultation
< 3 Months
Medication List (dose, frequency, route)
 
Current
Past medical history
 
Current
Description of gender history and gender medications
 
Current
Outline of question being asked
 
Current
Labs:
  • Estradiol
  • Free testosterone level
  • LH
  • CBC
  • Creatinine
  • Electrolytes
  • ALT
  • TSH
  • Hemoglobin A1c
  • Lipid panel
  • Apolipoprotein B100
 
N/A
Urgent: Examples - GAHT start with high level of gender dysphoria/difficulty functioning, possible GAHT complication, sex hormone sensitive cancer, complex decompensated medical condition query what to do with GAHT.
Immediate advice: Trans Health Specialist Link
For more details, please see Provincial Adult Gender-Affirming Care Primary Care Clinical Pathway
Access Targets:
  • Urgent: within 3 months
  • Semi-Urgent: 3-6 months
  • Routine: 6-12 months

+-
Emergent Reason for Referral
Additional Details
+-
Hypercalcemia
For Severe Hypercalcemia direct patients to Emergency department or call RAAPID South: 1-800-661-1700 or 403-944-4486.
+-
Hyperthyroidism
Hyperthyroidism with red flags, direct patients to Emergency department or call RAAPID South: 1-800-661-1700 or 403-944-4486.
Red Fags: Unstable or evidence of CHF, arrhythmia, chest pain
+-
Hypertriglyceridemia
Emergent: For Hypertriglyceridemia, direct patients to Emergency department or call RAAPID South: 1-800-661-1700 or 403-944-4486.
Hypertriglyceridemia:
  • Severe epigastric discomfort
  • nausea
  • emesis to suggest pancreatitis
+-
Type 1 diabetes mellitus
Emergent: For Type 1 Diabetes Mellitus, direct patients to Emergency department or call RAAPID South: 1-800-661-1700 or 403-944-4486.

The primary purpose of the All Locations list is to let the user easily access any location of a healthcare service without going back to the main search screen.

The locations listed have 3 background colors:
  • Green means the healthcare service@location has referral information attached to it.
  • Brown means the healthcare service@location never had referral information attached to it, or it has unpublished referral information.
  • Red means
    • IA changed the healthcare service@location's status to something other than Current
    • It was deleted if it is an ARD healthcare service@location.
Green  and Brown are always at the top of the list. These are the Healthcare Service@Locations with the status of Current.
The Red list at the bottom consists of non-current Healthcare Service@locations that once had Published referral information in the ARD.
If the referral information was never published in ARD the Healthcare Service@location will not show in the Red list.

The secondary purpose of the All Locations list is to allow ARD Administrators to recover (copy) referral information from the non-current Healthcare Service@Locations to ones that are current.

Common Scenario:
A Healthcare Service moves from one location to another. In this case the IA Healthcare Service@Location record will be made defunct (non-current) and a new Healthcare Service@Location record will be created with a current status. In this scenario the captured referral guidelines in ARD can become "orphaned" as they are not attached to any current IA healthcare service.

Categories of non-current or orphaned referral guidelines: INDIVIDUAL and COMMON.
The REFERRAL GUIDELINES section of the profile has the prefix INDIVIDUAL or COMMON to help you choose the method below when transferring referral guidelines from a non-current Healthcare Service@Location to a current healthcare service@location.

Individual referral process
  1. Click on a non-current (Red) Healthcare Service@Location at the bottom of the All Locations list.
  2. The non-current referral info is displayed with the link Copy this Referral Process to another Healthcare Service@Location link on the upper right hand corner. Click on the copy link.
  3. Choose a current location (Green or Brown) from the All Locations list. This will be the Healthcare Service@Location you are pasting the referral info into.
  4. The system will display the Edit Referral Info screen populated with the referral info from the non-current Healthcare Service@Location you viewed in the first step.
  5. Click Save and the referral info is transferred from the non-current Healthcare Service@Location to the current one.
  6. Repeat these steps for each Healthcare Service@Location that needs attention.

Common referral process - 2 sub cases.
Case 1: At least 1 current Healthcare Service@Location with common referral info is with current status for this healthcare service; One or more Healthcare Healthcare Service@Locations where replaced by new one.
  1. Click on any current Healthcare Service@Location whether it has referral info (Green) or not (Brown).
  2. The healthcare service location opens in the Edit Referral Info screen populated with the current common referral info.
  3. Save it. 
  4. All locations will be updated with the common referral information, including all the locations that don't have referral info yet (Brown). The non-current referrals (Red) will also be updated.
Case 2:  All Healthcare Healthcare Service@Locations for a healthcare service are set to a non-current status and replaced by new ones. In this case there is no current additional referral info to copy from, so the only alternative is to pick up the non-current common referral process (Red). Follow the steps described in the section Individual Referral Process above to copy/paste the non-current common referral info to the current healthcare service locations.
Generally we want to replicate current common referral info to new or replaced healthcare service locations. We only resort to copying non-current common referral info if there is no other option.

Remember: Some fields can be location specific with the common referral process:
Parking Instructions, Directions, Parking Map, Wait Time, Referral Phone or Referral Fax.
To update these items you have to edit each Healthcare Service@Location separately.

ADDITONAL NOTES:
  • The info icon after the All Locations drop down will be visible to ARD Administrators.
  • The system doesn't allow you to copy referral information from one non-current Healthcare Service@Location to another.

 

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