Professionals

NDD Care Coordination Project

If there is a family in your practice who you feel would benefit form care coordination, please complete the questions below.

If you checked both of the boxes above, please continue to the questions below. If you did not check both boxes above, this patient does not currently meet the inclusion criteria for the Care Coordination project but may in the future as we expand the target population.

If you clicked yes on the first 2 boxes (NDD diagnosis and significant medical issues) AND 1 or more of the additional boxes, please print the referral form below. Complete the referral form and fax to: 403-668-2150.

Download Referral Form

Download Information Sheet

	Have difficulty managing, scheduling and rescheduling appointments?
	Require support to navigate the health system?
	Need assistance with managing multiple medical recommendations?
	Face isolation, language or cultural barriers?
	Need help accessing educational and social supports?

NDD Care Coordination Project

Professionals

Does the child have:

Does this child and/or their family:

	A confirmed or pending diagnosis of ASD (Autism Spectrum Disorder) AND/OR ADHD (Attention Deficit Hyperactivity Disorder)
	Significant medical issues treated or followed at the Alberta Children's Hospital and/or Child and Adolescent Addiction, Mental Health & Psychiatry Program (CAAMHPP)