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Referral Form

Refer all newborns with OBPI to a multidisciplinary centre by 1 month of age.
With referral, provide complete pregnancy and birth history, and physical exam findings if available.

  • Contact and referral numbers are included on the face sheet
  • Relevant clinical information is included on the referral form
  • Refer infants to the most convenient centre for ongoing management
  • All surgeons and centres in Canada use the same referral form
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