Referral form
Occupational therapy referral
An occupational therapy referral asks an OT to assess function in real life: dressing, bathing, meals, cognition at home or work, equipment, and return-to-work tasks. It is not a physiotherapy referral with the letterhead changed. Community OT is often insurer, WCB, auto, VA, or Home and Community Care — not an open OHIP visit. Name the problem in the house or the job, not “OT please.”
What OT is being asked to do
OT treats the occupation, not the joint in isolation. “Cannot dress the lower body after hip replacement,” “cannot manage medications after a stroke,” and “cannot tolerate a full cognitive workload at a desk” are OT questions. “Sore shoulder, strengthen” is usually PT.
Use the destination’s current form. Home and Community Care, hospital outpatient, private OT, and WSIB/WCB programs are different doors. A hospital pad faxed to a private clinic is how the referral dies.
Falls are an environment problem too
If you are referring after falls, say where they fall, what they hit, and whether there are stairs, a tub, or no grab bars. “Unsteady” without a house is hard to assess from a gym.
Who completes it
The physician, nurse practitioner, or program that the OT service requires as a referrer. Some community OTs accept self-referral; payers often still want your letter. Do not sign an OT referral for a home you have never discussed with the patient.
How to complete the referral
- The functional problem: ADLs, IADLs, cognition, work tasks, driving is usually a different assessment.
- Diagnosis that explains the limit, and whether it is new or chronic.
- Home layout if you know it: stairs, bathroom, live-alone, caregiver.
- Cognitive or behavioural issues that affect safety (leaving the stove on, wandering).
- Precautions: weight-bearing, sternal, hip, seizure, aggression.
- Payer: HCCSS, WCB/WSIB, auto, VA, private. Claim numbers if you have them.
- Goal that is observable: independent tub transfer, meal prep with cues, graded return to keyboarding.
Worked example (fictional)
OT referral — stroke, home safety, family practice
Fictional 71-year-old. Do not copy into a real OT referral.
Dx: right MCA infarct 2026-07-02, left hemiparesis, mild neglect. Discharged home with spouse 2026-07-20. Problem: cannot dress lower body independently; tub is a high-sided soaker; spouse reports near-falls at night. Cognition: follows two-step commands, forgets stove twice. Goal: safe tub transfers, dressing strategy, stove-safety recommendations. Not asking for outpatient PT on this sheet (already booked). Payer: Home and Community Care if eligible; otherwise private. Not WSIB. Precautions: left-sided weakness, supervision on stairs. I am the FP.
Why OT referrals bounce
- A PT diagnosis with no functional or environmental question.
- No payer.
- Home-care referral that belongs on the HCCSS form, not a private-clinic pad.
- Driving clearance requested as if OT were MTO.
- No precautions after recent surgery.
Draft the OT referral from the visit
In Scribeberry, open Forms, search for occupational therapy referral, or upload the service’s current PDF. Generate from the encounter and your notes, then review every field before you send. Scribeberry does not pre-map this form. You still review and sign. Scribeberry does not book OT.
Frequently asked questions
When do I use Home and Community Care instead?
If you want publicly funded home OT, nursing, or PSW in Ontario, use the HCCSS referral. A private OT clinic form will not open that stream.
Can OT complete a Functional Abilities Form?
Sometimes, if they have assessed the worker and the board or employer accepts that profession on that form. Your referral is not a FAF. Complete the FAF separately if WSIB asked for it.
Is this a driving assessment?
Only if you are referring to a driving-assessment program and the form says so. Fitness-to-drive reporting to MTO or another registrar is a different process.
Does Scribeberry send this to OT?
No. Scribeberry helps you complete the PDF. You or the clinic send it. Keep a copy in the chart.
Forms
