Several of our primary care clinics use TELUS PS Suites (PSS). This effort to share existing PSS Custom Forms (.cfm files) is a collaboration of several  FLA Ontario Health Team health care partners and the Digital Technology Working Group.

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• Click on the zip folder below to download the desired cfm file(s), which can then be imported to PSS Custom Forms. If zip folder contains more than one cfm file, files are listed below folder name.

• Click on view PDF to see PDF version on source website, if available.

Do you have a PSS Custom Form (.cfm file) to share or update?

Brockville General Hospital (Brockville GH)

• Brockville GH Diagnostic Imaging zip folder includes:

  • Bone Density Requisition/Questionnaire  (view PDF)

  • General Radiology-Fluoro Requisition  (view PDF)

  • Mammography Requisition  (view PDF)

  • Ultrasound-Echocardiography Requisition  (view PDF)

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Hotel Dieu Hospital (HDH)

• Audiology Referral zip folder  (view PDF)

• Breast Imaging Requisition zip folder  (View PDF)

• Chronic Pain Clinic Referral zip folder  (view PDF)

• Dysphagia Referral zip folder

• GI Function Testing Requisition  (view PDF)

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Kingston Cardiology Associates (website) 

• Vascular Laboratory Referral zip folder

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Kingston Health Sciences Centre (KHSC) 

• KHSC CT Requisition  (view PDF)

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• Gastroenterology zip folder includes:

  • KHSC Gastroenterology Direct to Procedure Upper Endoscopy - Dyspepsia May2022.cfm​

  • KHSC Gastroenterology Direct to Procedure Upper Endoscopy - GERD May2022.cfm

  • KHSC Gastroenterology Liver Clinic Referral NAFLD Feb2022.cfm

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• KHSC General Internal Medicine Referral zip folder​  (view PDF)

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• General Surgery Referral zip folder​​​​​

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Kingston MRI

• Kingston MRI Requisition zip folder (view PDF)

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Limestone City Sleep Lab

• Sleep Disorder Referral zip folder  (view PDF)

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Lennox & Addington County General Hospital (LACGH) 

• Diagnostic Imaging zip folder includes:

  • Bone Mineral Density/Mammography (BMD/MAMMO)  (view PDF)

  • Computed Tomography (CT)​  (view PDF)

  • Echocardiography  (view PDF)

  • General Ultrasound  (view PDF)

  • Interventional Radiology (IVR)  (view PDF)

  • Obstetric Ultrasound  (view PDF)

  • X-ray  (view PDF)

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• Cardiac Diagnostic Services Requisition zip folder  (view PDF)​

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Limestone City Sleep Lab

• Sleep Disorder Referral zip folder  (view PDF)​

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Perth & Smith Falls District Hospital

• Diagnostic Imaging zip folder includes:

  • Ultrasound Request​

  • X-ray Request

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Providence Care Hospital (PCH) 

• Palliative Care Consult Team Referral zip folder (view PDF)

• Physical Medicine and Rehabilitation Outpatient Clinic Referral zip folder  (view PDF)

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Quinte Health Care  (QHC)

• Diagnostic Imaging Requisitions zip folder includes:

  • Bone Mineral Density (view PDF)

  • Breast Imaging - Mammo ​(view PDF)

  • Breast MRI (view PDF)

  • CardioPulmonary Services (view PDF)

  • CT (view PDF)

  • Interventional Radiology (view PDF)

  • Magnetic Resonance Imaging (view PDF)

  • Radiology X-Ray (view PDF)

  • Ultrasound (view PDF)

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South East Ontario Addictions & Mental Health Service (AMHS)

• AMHS Access Form zip folder

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