Community Paramedic Internal Referral
This form has been created for the express use of Paramedics and First Responders that work with the ERS network.
The Shared Health Community Paramedic Program currently has locations in Brandon, Selkirk and Boundary Trails, referrals will be accepted for patients that reside within a 60-minute drive from these locations.
We cannot guarantee a time sensitive response for patients that have unstable vital signs, acute medical concern or a patient that refuses transport. If a referral has been submitted and the patient is not transported, please advise them to call 911 back if their symptoms change and they need emergency care.
When completing this form please fill out as much information as possible. Due to privacy legislation, it is important that you let us know if you have obtained consent from the patient prior to submitting this form.
If you encounter any difficulty submitting this form please call the Community Paramedic Intake line, 204-926-1302.
Shared Health Paramedics are encouraged to securely 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
- Boundary Trails Fax: 204-235-0895