The referral routes SOHT partners have agreed for people with complex needs. Each one says who it is for, who leads it and how to refer.
SAFE-ALC — Support At-risk Frail Elderly
For: frail older adults at risk of becoming Alternate Level of Care in hospital, or of admission from the community. Lead: TransCare Community Support Services. How to refer: complete the SAFE-ALC referral form (PDF) and send it as the form directs; the team responds within two business days.
Diabetes pathway — prevention and surveillance
For: adults with, or at high risk of, type 2 diabetes. Leads: Scarborough Health Network and Carefirst Seniors and Community Services. How to refer: centralized diabetes e-referral through the Ontario eServices Program from your EMR; education and self-management programs accept self-referral.
Ontario eServices — eReferral and eConsult
Send referrals and specialist consultations electronically from your EMR through the Ontario eServices Program; SOHT’s Digital Health Committee supports onboarding. eConsult answers most questions within two days and avoids a specialist visit for the patient.
Mental health and addictions — community first
For: people who would otherwise go to the Emergency Department for mental health or addictions care. Leads: Canadian Mental Health Association Toronto and Hong Fook Mental Health Association, with the Quality and Performance Committee. How to refer: through the Toronto Health and Social Services Directory listings for each service; centralized intake is being built.
Surge prevention and vaccination
Each fall the Recovery and Sustainability Committee plans flu, COVID-19 and RSV clinics in priority neighbourhoods, led by Scarborough Centre for Healthy Communities. Providers can direct patients to the vaccine and assessment site map or to register for vaccine notifications.
Missing a pathway? Tell us through the feedback form; the PCN clinical co-leads review provider feedback monthly.
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