REHAB Finder

Referral FORMS

Best PRACTICES Day

Joint Replacement (Hip, Knee, Shoulder)

The GTA Rehab Network has developed a standardized outpatient rehabilitation model of care for total joint replacement patients to ensure they experience a smooth transition from acute care to outpatient rehabilitation. A variety of forms and tools support the model.

Outpatient Rehab Model, Tools and Resources
Guideline for TJR Pre-Operative Processes (Rev. Nov 2019) This guideline includes processes in the pre-operative, acute care admission and outpatient rehabilitation phases; pre-operative triage considerations for referral to outpatient/inpatient rehabilitation; and referral criteria for Home and Community Care.
TJR Outpatient Rehab Process Maps (Rev. Feb 2018) These process maps include responsibilities for acute care and inpatient rehabilitation to support the smooth transition of patients to outpatient rehabilitation.
Outpatient Rehab Referral for Hip, Knee or Shoulder Surgery (PDF) (March 2023)

Outpatient Rehab Referral for Hip, Knee or Shoulder Surgery (Fillable) (March 2023)

 Use this outpatient rehab referral form for hip, knee and shoulder replacement or revision provided by member organizations of the GTA Rehab Network.
GTA Rehab Network Hip and Knee Bundled Care Outcome Reporting Form (March 2020)

Version A – Bundle provider to indicate if outcomes have been met for each individual outcome criterion.

Version B – Bundle provider to indicate if overall outcomes have been met.

 One of the standardized outcome reporting forms is to be completed by bundle providers if requested by bundle holders when:

  • additional information on a particular patient is needed. Request to be made in writing at the time of referral.
  • there is no standing agreement in place with a Community Physiotherapy Clinic or other bundle provider.
Shoulder Bundled Care Outcome Reporting Form (April 2021) This shoulder outcome reporting form has been developed and shared by the Scarborough Health Network. It has been adapted from the bundled care outcome reporting forms of the GTA Rehab Network and Lakeridge Health. It can be customized for use in organizations along with the acknowledgement: Adapted from the Bundled Care Outcome Reporting Forms of the Scarborough Health Network, GTA Rehab Network & Lakeridge Health.
TJR Outpatient Rehab Follow-Up Form (June 2014) This form supports the communication between the outpatient rehabilitation physiotherapist and the client’s orthopaedic surgeon.
GTA Transportation Options (February 2022) A resource listing for use in assisting patients requiring transportation to outpatient rehab.
Listing of Outpatient Rehab Programs that Accept Hip, Knee or Shoulder Surgery External Referrals (May 2023) This comprehensive listing identifies outpatient rehab programs across the GTA that will accept external referrals for outpatient rehab following hip, knee, and shoulder replacement or revision.