Community Paramedic Internal Referral

This form has been created for the express use of Paramedics and First Responders that work with in the ERS network.

Thank you for placing a referral to the Shared Health Community Paramedic Program, be advised that the program is only operational in the Brandon and Selkirk area.

When filling out the form please provide as much information as possible, this will help us ensure a timely response to the referred patient. Due to privacy laws it is important that you let us know if you have obtained consent from the patient prior to submitting this form.

If you encounter difficulty submitting this form please call the Community Paramedic Intake line, 204-926-1302.

Shared Health Paramedics can also fax a copy of the PCR to the CP office, but this must be done in conjunction with submitting the form below.

• Brandon Fax: 204-728-5329
• Selkirk Fax: 204-785-1617