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CISSS des Laurentides – Hôpital de Saint-Jérôme fax number

(450) 431-8314

Hôpital de Saint-Jérôme

Used for: Referral to the Regional TCCL program for mild traumatic brain injury; fax the Grille de repérage TCCL (G-3047) and accompanying clinical documentation to the external number.

Fax destination details

Department
Hôpital de Saint-Jérôme
Purpose
Referral to the Regional TCCL program for mild traumatic brain injury; fax the Grille de repérage TCCL (G-3047) and accompanying clinical documentation to the external number.
Form
G-3047 Grille de repérage Traumatisme Crânio-Cérébral Léger (TCCL) – Laurentides — Grille de repérage TCCL Léger (G-3047)
Address
290, rue de Montigny, Saint-Jérôme, QC J7Z 5T3
Voice phone
450-432-2777

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Fill out the Grille de repérage TCCL; if the diagnostic criteria are met, refer the client to the Regional TCCL program in the Laurentides. Fax the form and clinical documents to 450-431-8314.

Official form instructions are published as a downloadable file on the organization's website.

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