{
  "resourceType": "CodeSystem",
  "id": "example-referral-form-codes",
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem example-referral-form-codes</b></p><a name=\"example-referral-form-codes\"> </a><a name=\"hcexample-referral-form-codes\"> </a><p>This case-sensitive code system <code>http://ontariohealth.ca/fhir/eforms/CodeSystem/example-referral-form-codes</code> defines the following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>French (fr)</b></td></tr><tr><td style=\"white-space:nowrap\">20001<a name=\"example-referral-form-codes-20001\"> </a></td><td>Cardiac Testing</td><td/></tr><tr><td style=\"white-space:nowrap\">20002<a name=\"example-referral-form-codes-20002\"> </a></td><td>Cardiology Consultation</td><td/></tr><tr><td style=\"white-space:nowrap\">20003<a name=\"example-referral-form-codes-20003\"> </a></td><td>24 Hour Ambulatory Blood Pressure Monitoring (Not OHIP Covered)</td><td/></tr><tr><td style=\"white-space:nowrap\">20004<a name=\"example-referral-form-codes-20004\"> </a></td><td>Coronary Angiogram</td><td/></tr><tr><td style=\"white-space:nowrap\">20005<a name=\"example-referral-form-codes-20005\"> </a></td><td>Echocardiogram - Resting</td><td/></tr><tr><td style=\"white-space:nowrap\">20006<a name=\"example-referral-form-codes-20006\"> </a></td><td>Electrocardiogram (ECG)</td><td/></tr><tr><td style=\"white-space:nowrap\">20007<a name=\"example-referral-form-codes-20007\"> </a></td><td>Holter Monitoring</td><td/></tr><tr><td style=\"white-space:nowrap\">20008<a name=\"example-referral-form-codes-20008\"> </a></td><td>Loop / Event Monitor</td><td/></tr><tr><td style=\"white-space:nowrap\">20009<a name=\"example-referral-form-codes-20009\"> </a></td><td>Stress Testing</td><td/></tr><tr><td style=\"white-space:nowrap\">20010<a name=\"example-referral-form-codes-20010\"> </a></td><td>Nuclear Medicine</td><td/></tr><tr><td style=\"white-space:nowrap\">20011<a name=\"example-referral-form-codes-20011\"> </a></td><td>Tilt Table Testing</td><td/></tr><tr><td style=\"white-space:nowrap\">20012<a name=\"example-referral-form-codes-20012\"> </a></td><td>Echocardiogram (2D)</td><td/></tr><tr><td style=\"white-space:nowrap\">20013<a name=\"example-referral-form-codes-20013\"> </a></td><td>Echocardiogram with Contrast</td><td/></tr><tr><td style=\"white-space:nowrap\">20014<a name=\"example-referral-form-codes-20014\"> </a></td><td>Echocardiogram with Saline (Bubble)</td><td/></tr><tr><td style=\"white-space:nowrap\">20015<a name=\"example-referral-form-codes-20015\"> </a></td><td>Pediatric Echocardiogram</td><td/></tr><tr><td style=\"white-space:nowrap\">20016<a name=\"example-referral-form-codes-20016\"> </a></td><td>Transesophageal Echocardiogram (TEE)</td><td/></tr><tr><td style=\"white-space:nowrap\">20017<a name=\"example-referral-form-codes-20017\"> </a></td><td>24 Hours</td><td/></tr><tr><td style=\"white-space:nowrap\">20018<a name=\"example-referral-form-codes-20018\"> </a></td><td>48 Hours</td><td/></tr><tr><td style=\"white-space:nowrap\">20019<a name=\"example-referral-form-codes-20019\"> </a></td><td>72 Hours</td><td/></tr><tr><td style=\"white-space:nowrap\">20020<a name=\"example-referral-form-codes-20020\"> </a></td><td>7 Days</td><td/></tr><tr><td style=\"white-space:nowrap\">20021<a name=\"example-referral-form-codes-20021\"> </a></td><td>14 Days</td><td/></tr><tr><td style=\"white-space:nowrap\">20022<a name=\"example-referral-form-codes-20022\"> </a></td><td>ECG - Exercise Stress Test</td><td/></tr><tr><td style=\"white-space:nowrap\">20023<a name=\"example-referral-form-codes-20023\"> </a></td><td>ECG - Dobutamine/Persantine Stress Test</td><td/></tr><tr><td style=\"white-space:nowrap\">20024<a name=\"example-referral-form-codes-20024\"> </a></td><td>Echocardiogram - Exercise Stress Test</td><td/></tr><tr><td style=\"white-space:nowrap\">20025<a name=\"example-referral-form-codes-20025\"> </a></td><td>Echocardiogram - Dobutamine/Persantine Stress Test</td><td/></tr><tr><td style=\"white-space:nowrap\">20026<a name=\"example-referral-form-codes-20026\"> </a></td><td>MUGA - Resting</td><td/></tr><tr><td style=\"white-space:nowrap\">20027<a name=\"example-referral-form-codes-20027\"> </a></td><td>Cardiac Pyrophosphate</td><td/></tr><tr><td style=\"white-space:nowrap\">20028<a name=\"example-referral-form-codes-20028\"> </a></td><td>MIBI Scans / Myocardial Perfusion Imaging (MPI):</td><td/></tr><tr><td style=\"white-space:nowrap\">20029<a name=\"example-referral-form-codes-20029\"> </a></td><td>MIBI Scan - Exercise Stress Test</td><td/></tr><tr><td style=\"white-space:nowrap\">20030<a name=\"example-referral-form-codes-20030\"> </a></td><td>MIBI Scan - Dobutamine/Persantine Stress Test</td><td/></tr><tr><td style=\"white-space:nowrap\">20031<a name=\"example-referral-form-codes-20031\"> </a></td><td>Thallium Viability Test</td><td/></tr><tr><td style=\"white-space:nowrap\">20032<a name=\"example-referral-form-codes-20032\"> </a></td><td>Arrythmias or Palpitations</td><td/></tr><tr><td style=\"white-space:nowrap\">20033<a name=\"example-referral-form-codes-20033\"> </a></td><td>Cardiovascular Risk Assessment</td><td/></tr><tr><td style=\"white-space:nowrap\">20034<a name=\"example-referral-form-codes-20034\"> </a></td><td>Chest Pain or Angina</td><td/></tr><tr><td style=\"white-space:nowrap\">20035<a name=\"example-referral-form-codes-20035\"> </a></td><td>Congenital Heart Disease</td><td/></tr><tr><td style=\"white-space:nowrap\">20036<a name=\"example-referral-form-codes-20036\"> </a></td><td>Congestive Heart Failure</td><td/></tr><tr><td style=\"white-space:nowrap\">20037<a name=\"example-referral-form-codes-20037\"> </a></td><td>Coronary Artery Disease</td><td/></tr><tr><td style=\"white-space:nowrap\">20038<a name=\"example-referral-form-codes-20038\"> </a></td><td>Dyspnea</td><td/></tr><tr><td style=\"white-space:nowrap\">20039<a name=\"example-referral-form-codes-20039\"> </a></td><td>Hypertension</td><td/></tr><tr><td style=\"white-space:nowrap\">20040<a name=\"example-referral-form-codes-20040\"> </a></td><td>Murmur</td><td/></tr><tr><td style=\"white-space:nowrap\">20041<a name=\"example-referral-form-codes-20041\"> </a></td><td>Pericardial Disease</td><td/></tr><tr><td style=\"white-space:nowrap\">20042<a name=\"example-referral-form-codes-20042\"> </a></td><td>Peripheral Edema</td><td/></tr><tr><td style=\"white-space:nowrap\">20043<a name=\"example-referral-form-codes-20043\"> </a></td><td>Post-Myocardial Infarction</td><td/></tr><tr><td style=\"white-space:nowrap\">20044<a name=\"example-referral-form-codes-20044\"> </a></td><td>Pre-Operative Consultation</td><td/></tr><tr><td style=\"white-space:nowrap\">20045<a name=\"example-referral-form-codes-20045\"> </a></td><td>Syncope</td><td/></tr><tr><td style=\"white-space:nowrap\">20046<a name=\"example-referral-form-codes-20046\"> </a></td><td>Valvular Heart Disease or Prosthetic Heart Valve</td><td/></tr><tr><td style=\"white-space:nowrap\">20047<a name=\"example-referral-form-codes-20047\"> </a></td><td>Acne or Rosacea</td><td/></tr><tr><td style=\"white-space:nowrap\">20048<a name=\"example-referral-form-codes-20048\"> </a></td><td>Alopecia or Hair Loss</td><td/></tr><tr><td style=\"white-space:nowrap\">20049<a name=\"example-referral-form-codes-20049\"> </a></td><td>Cosmetic</td><td/></tr><tr><td style=\"white-space:nowrap\">20050<a name=\"example-referral-form-codes-20050\"> </a></td><td>Eczema or Dermatitis</td><td/></tr><tr><td style=\"white-space:nowrap\">20051<a name=\"example-referral-form-codes-20051\"> </a></td><td>Hidradenitis Suppurativa</td><td/></tr><tr><td style=\"white-space:nowrap\">20052<a name=\"example-referral-form-codes-20052\"> </a></td><td>Hives or Urticaria</td><td/></tr><tr><td style=\"white-space:nowrap\">20053<a name=\"example-referral-form-codes-20053\"> </a></td><td>Nail Concerns</td><td/></tr><tr><td style=\"white-space:nowrap\">20054<a name=\"example-referral-form-codes-20054\"> </a></td><td>Pruritus NYD</td><td/></tr><tr><td style=\"white-space:nowrap\">20055<a name=\"example-referral-form-codes-20055\"> </a></td><td>Psoriasis</td><td/></tr><tr><td style=\"white-space:nowrap\">20056<a name=\"example-referral-form-codes-20056\"> </a></td><td>Rash NYD</td><td/></tr><tr><td style=\"white-space:nowrap\">20057<a name=\"example-referral-form-codes-20057\"> </a></td><td>Skin Cancer or Suspicious Lesion(s)</td><td/></tr><tr><td style=\"white-space:nowrap\">20058<a name=\"example-referral-form-codes-20058\"> </a></td><td>Skin Check</td><td/></tr><tr><td style=\"white-space:nowrap\">20059<a name=\"example-referral-form-codes-20059\"> </a></td><td>Skin Infection - Chronic</td><td/></tr><tr><td style=\"white-space:nowrap\">20060<a name=\"example-referral-form-codes-20060\"> </a></td><td>Ulcer or Wounds</td><td/></tr><tr><td style=\"white-space:nowrap\">20061<a name=\"example-referral-form-codes-20061\"> </a></td><td>Warts</td><td/></tr><tr><td style=\"white-space:nowrap\">20062<a name=\"example-referral-form-codes-20062\"> </a></td><td>Vitiligo</td><td/></tr><tr><td style=\"white-space:nowrap\">20063<a name=\"example-referral-form-codes-20063\"> </a></td><td>Actinic Keratoses</td><td/></tr><tr><td style=\"white-space:nowrap\">20064<a name=\"example-referral-form-codes-20064\"> </a></td><td>Basal Cell Cancer</td><td/></tr><tr><td style=\"white-space:nowrap\">20065<a name=\"example-referral-form-codes-20065\"> </a></td><td>Squamous Cell Cancer</td><td/></tr><tr><td style=\"white-space:nowrap\">20066<a name=\"example-referral-form-codes-20066\"> </a></td><td>Melanoma</td><td/></tr><tr><td style=\"white-space:nowrap\">20067<a name=\"example-referral-form-codes-20067\"> </a></td><td>Suspicious Lesion(s)</td><td/></tr><tr><td style=\"white-space:nowrap\">20068<a name=\"example-referral-form-codes-20068\"> </a></td><td>Biopsy confirmed</td><td/></tr><tr><td style=\"white-space:nowrap\">20069<a name=\"example-referral-form-codes-20069\"> </a></td><td>Abdominal Pain NYD or Bloating</td><td/></tr><tr><td style=\"white-space:nowrap\">20070<a name=\"example-referral-form-codes-20070\"> </a></td><td>Barrett's Esophagus - Surveillance</td><td/></tr><tr><td style=\"white-space:nowrap\">20071<a name=\"example-referral-form-codes-20071\"> </a></td><td>Bleeding</td><td/></tr><tr><td style=\"white-space:nowrap\">20072<a name=\"example-referral-form-codes-20072\"> </a></td><td>Colonoscopy Request (Abnormal FIT, Screening, Surveillance)</td><td/></tr><tr><td style=\"white-space:nowrap\">20073<a name=\"example-referral-form-codes-20073\"> </a></td><td>Bowel Changes (Constipation, Diarrhea)</td><td/></tr><tr><td style=\"white-space:nowrap\">20074<a name=\"example-referral-form-codes-20074\"> </a></td><td>Dysphagia</td><td/></tr><tr><td style=\"white-space:nowrap\">20075<a name=\"example-referral-form-codes-20075\"> </a></td><td>Gastroesophageal Reflux Disease (GERD)</td><td/></tr><tr><td style=\"white-space:nowrap\">20076<a name=\"example-referral-form-codes-20076\"> </a></td><td>Irritable Bowel Syndrome</td><td/></tr><tr><td style=\"white-space:nowrap\">20077<a name=\"example-referral-form-codes-20077\"> </a></td><td>Inflammatory Bowel Disease (IBD)</td><td/></tr><tr><td style=\"white-space:nowrap\">20078<a name=\"example-referral-form-codes-20078\"> </a></td><td>Iron Deficiency Anemia - Unexplained</td><td/></tr><tr><td style=\"white-space:nowrap\">20079<a name=\"example-referral-form-codes-20079\"> </a></td><td>Liver Disease</td><td/></tr><tr><td style=\"white-space:nowrap\">20080<a name=\"example-referral-form-codes-20080\"> </a></td><td>Nausea or Vomiting NYD</td><td/></tr><tr><td style=\"white-space:nowrap\">20081<a name=\"example-referral-form-codes-20081\"> </a></td><td>Pancreatic Disease</td><td/></tr><tr><td style=\"white-space:nowrap\">20082<a name=\"example-referral-form-codes-20082\"> </a></td><td>Weight Loss - Unexplained</td><td/></tr><tr><td style=\"white-space:nowrap\">20083<a name=\"example-referral-form-codes-20083\"> </a></td><td>Lower GI or Rectal</td><td/></tr><tr><td style=\"white-space:nowrap\">20084<a name=\"example-referral-form-codes-20084\"> </a></td><td>Upper GI</td><td/></tr><tr><td style=\"white-space:nowrap\">20085<a name=\"example-referral-form-codes-20085\"> </a></td><td>Constipation</td><td/></tr><tr><td style=\"white-space:nowrap\">20086<a name=\"example-referral-form-codes-20086\"> </a></td><td>Diarrhea</td><td/></tr><tr><td style=\"white-space:nowrap\">20087<a name=\"example-referral-form-codes-20087\"> </a></td><td>Abnormal FIT</td><td/></tr><tr><td style=\"white-space:nowrap\">20088<a name=\"example-referral-form-codes-20088\"> </a></td><td>Average Risk</td><td/></tr><tr><td style=\"white-space:nowrap\">20089<a name=\"example-referral-form-codes-20089\"> </a></td><td>First-Degree Relative with Colorectal Cancer</td><td/></tr><tr><td style=\"white-space:nowrap\">20090<a name=\"example-referral-form-codes-20090\"> </a></td><td>Other Family History</td><td/></tr><tr><td style=\"white-space:nowrap\">20091<a name=\"example-referral-form-codes-20091\"> </a></td><td>Prior History of Colorectal Polyps</td><td/></tr><tr><td style=\"white-space:nowrap\">20092<a name=\"example-referral-form-codes-20092\"> </a></td><td>Prior History of Colorectal Cancer</td><td/></tr><tr><td style=\"white-space:nowrap\">20093<a name=\"example-referral-form-codes-20093\"> </a></td><td>Surveillance in IBD Colitis of at least 8 years duration</td><td/></tr><tr><td style=\"white-space:nowrap\">20094<a name=\"example-referral-form-codes-20094\"> </a></td><td>Crohn's disease</td><td/></tr><tr><td style=\"white-space:nowrap\">20095<a name=\"example-referral-form-codes-20095\"> </a></td><td>Ulcerative colitis</td><td/></tr><tr><td style=\"white-space:nowrap\">20096<a name=\"example-referral-form-codes-20096\"> </a></td><td>Alcohol Associated Liver Disease</td><td/></tr><tr><td style=\"white-space:nowrap\">20097<a name=\"example-referral-form-codes-20097\"> </a></td><td>Cirrhosis</td><td/></tr><tr><td style=\"white-space:nowrap\">20098<a name=\"example-referral-form-codes-20098\"> </a></td><td>Hepatitis B</td><td/></tr><tr><td style=\"white-space:nowrap\">20099<a name=\"example-referral-form-codes-20099\"> </a></td><td>Hepatitis C</td><td/></tr><tr><td style=\"white-space:nowrap\">20100<a name=\"example-referral-form-codes-20100\"> </a></td><td>Liver Function Tests - Abnormal</td><td/></tr><tr><td style=\"white-space:nowrap\">20101<a name=\"example-referral-form-codes-20101\"> </a></td><td>Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) / Fatty Liver</td><td/></tr><tr><td style=\"white-space:nowrap\">20102<a name=\"example-referral-form-codes-20102\"> </a></td><td>Abnormal Imaging of Pancreas</td><td/></tr><tr><td style=\"white-space:nowrap\">20103<a name=\"example-referral-form-codes-20103\"> </a></td><td>Pancreatitis</td><td/></tr><tr><td style=\"white-space:nowrap\">20104<a name=\"example-referral-form-codes-20104\"> </a></td><td>Ear and Hearing</td><td/></tr><tr><td style=\"white-space:nowrap\">20105<a name=\"example-referral-form-codes-20105\"> </a></td><td>Facial Plastics &amp; Reconstruction</td><td/></tr><tr><td style=\"white-space:nowrap\">20106<a name=\"example-referral-form-codes-20106\"> </a></td><td>Head, Neck and Thyroid (Malignancy, Masses, Nodules, or Cysts)</td><td/></tr><tr><td style=\"white-space:nowrap\">20107<a name=\"example-referral-form-codes-20107\"> </a></td><td>Nose and Sinus</td><td/></tr><tr><td style=\"white-space:nowrap\">20108<a name=\"example-referral-form-codes-20108\"> </a></td><td>Throat and Oral Cavity</td><td/></tr><tr><td style=\"white-space:nowrap\">20109<a name=\"example-referral-form-codes-20109\"> </a></td><td>Cerumen Impaction</td><td/></tr><tr><td style=\"white-space:nowrap\">20110<a name=\"example-referral-form-codes-20110\"> </a></td><td>Eustachian Tube Dysfunction</td><td/></tr><tr><td style=\"white-space:nowrap\">20111<a name=\"example-referral-form-codes-20111\"> </a></td><td>Hearing Loss - Sudden / Unilateral</td><td/></tr><tr><td style=\"white-space:nowrap\">20112<a name=\"example-referral-form-codes-20112\"> </a></td><td>Otitis Externa</td><td/></tr><tr><td style=\"white-space:nowrap\">20113<a name=\"example-referral-form-codes-20113\"> </a></td><td>Otitis Media</td><td/></tr><tr><td style=\"white-space:nowrap\">20114<a name=\"example-referral-form-codes-20114\"> </a></td><td>Tinnitus</td><td/></tr><tr><td style=\"white-space:nowrap\">20115<a name=\"example-referral-form-codes-20115\"> </a></td><td>Vertigo or Dizziness</td><td/></tr><tr><td style=\"white-space:nowrap\">20116<a name=\"example-referral-form-codes-20116\"> </a></td><td>Nasopharyngeal Lesions</td><td/></tr><tr><td style=\"white-space:nowrap\">20117<a name=\"example-referral-form-codes-20117\"> </a></td><td>Oropharyngeal Lesions</td><td/></tr><tr><td style=\"white-space:nowrap\">20118<a name=\"example-referral-form-codes-20118\"> </a></td><td>Parathyroid Cyst, Nodule, or Mass</td><td/></tr><tr><td style=\"white-space:nowrap\">20119<a name=\"example-referral-form-codes-20119\"> </a></td><td>Salivary Gland Mass</td><td/></tr><tr><td style=\"white-space:nowrap\">20120<a name=\"example-referral-form-codes-20120\"> </a></td><td>Skin Cancer</td><td/></tr><tr><td style=\"white-space:nowrap\">20121<a name=\"example-referral-form-codes-20121\"> </a></td><td>Thyroid Cyst, Nodule, or Mass</td><td/></tr><tr><td style=\"white-space:nowrap\">20122<a name=\"example-referral-form-codes-20122\"> </a></td><td>Anosmia or Hyposmia</td><td/></tr><tr><td style=\"white-space:nowrap\">20123<a name=\"example-referral-form-codes-20123\"> </a></td><td>Deviated Nasal Septum</td><td/></tr><tr><td style=\"white-space:nowrap\">20124<a name=\"example-referral-form-codes-20124\"> </a></td><td>Epistaxis</td><td/></tr><tr><td style=\"white-space:nowrap\">20125<a name=\"example-referral-form-codes-20125\"> </a></td><td>Foreign Body Removal</td><td/></tr><tr><td style=\"white-space:nowrap\">20126<a name=\"example-referral-form-codes-20126\"> </a></td><td>Nasal Polyps</td><td/></tr><tr><td style=\"white-space:nowrap\">20127<a name=\"example-referral-form-codes-20127\"> </a></td><td>Rhinitis or Sinusitis - Chronic</td><td/></tr><tr><td style=\"white-space:nowrap\">20128<a name=\"example-referral-form-codes-20128\"> </a></td><td>Cough or Throat Clearing - Chronic</td><td/></tr><tr><td style=\"white-space:nowrap\">20130<a name=\"example-referral-form-codes-20130\"> </a></td><td>Dysphonia / Hoarse voice</td><td/></tr><tr><td style=\"white-space:nowrap\">20131<a name=\"example-referral-form-codes-20131\"> </a></td><td>Globus Sensation</td><td/></tr><tr><td style=\"white-space:nowrap\">20132<a name=\"example-referral-form-codes-20132\"> </a></td><td>Lymphadenopathy</td><td/></tr><tr><td style=\"white-space:nowrap\">20133<a name=\"example-referral-form-codes-20133\"> </a></td><td>Odynophagia</td><td/></tr><tr><td style=\"white-space:nowrap\">20134<a name=\"example-referral-form-codes-20134\"> </a></td><td>Salivary Gland Stones</td><td/></tr><tr><td style=\"white-space:nowrap\">20135<a name=\"example-referral-form-codes-20135\"> </a></td><td>Sleep-Related Breathing Disorders (e.g. OSA)</td><td/></tr><tr><td style=\"white-space:nowrap\">20136<a name=\"example-referral-form-codes-20136\"> </a></td><td>Speech and Language Delay</td><td/></tr><tr><td style=\"white-space:nowrap\">20137<a name=\"example-referral-form-codes-20137\"> </a></td><td>Tongue Tie</td><td/></tr><tr><td style=\"white-space:nowrap\">20138<a name=\"example-referral-form-codes-20138\"> </a></td><td>Tonsillar or Adenoid Disorders</td><td/></tr><tr><td style=\"white-space:nowrap\">20139<a name=\"example-referral-form-codes-20139\"> </a></td><td>Respiratory Testing</td><td/></tr><tr><td style=\"white-space:nowrap\">20140<a name=\"example-referral-form-codes-20140\"> </a></td><td>Respirology Consultation</td><td/></tr><tr><td style=\"white-space:nowrap\">20141<a name=\"example-referral-form-codes-20141\"> </a></td><td>Spirometry (Include post-bronchodilator, if indicated)</td><td/></tr><tr><td style=\"white-space:nowrap\">20142<a name=\"example-referral-form-codes-20142\"> </a></td><td>Full Pulmonary Function Testing (Include post-bronchodilator, if indicated)</td><td/></tr><tr><td style=\"white-space:nowrap\">20143<a name=\"example-referral-form-codes-20143\"> </a></td><td>Asthma</td><td/></tr><tr><td style=\"white-space:nowrap\">20144<a name=\"example-referral-form-codes-20144\"> </a></td><td>Cough NYD</td><td/></tr><tr><td style=\"white-space:nowrap\">20145<a name=\"example-referral-form-codes-20145\"> </a></td><td>Chronic Obstructive Pulmonary Disease (COPD)</td><td/></tr><tr><td style=\"white-space:nowrap\">20146<a name=\"example-referral-form-codes-20146\"> </a></td><td>Dyspnea NYD</td><td/></tr><tr><td style=\"white-space:nowrap\">20147<a name=\"example-referral-form-codes-20147\"> </a></td><td>Interstitial Lung Disease</td><td/></tr><tr><td style=\"white-space:nowrap\">20148<a name=\"example-referral-form-codes-20148\"> </a></td><td>Adrenal Mass</td><td/></tr><tr><td style=\"white-space:nowrap\">20149<a name=\"example-referral-form-codes-20149\"> </a></td><td>Benign Prostatic Hyperplasia (BPH) / Lower Urinary Tract Symptoms (LUTS)</td><td/></tr><tr><td style=\"white-space:nowrap\">20150<a name=\"example-referral-form-codes-20150\"> </a></td><td>Bladder Mass</td><td/></tr><tr><td style=\"white-space:nowrap\">20151<a name=\"example-referral-form-codes-20151\"> </a></td><td>Elevated Prostate-Specific Antigen (PSA) or Suspicious Digital Rectal Exam (DRE)</td><td/></tr><tr><td style=\"white-space:nowrap\">20152<a name=\"example-referral-form-codes-20152\"> </a></td><td>Erectile Dysfunction</td><td/></tr><tr><td style=\"white-space:nowrap\">20153<a name=\"example-referral-form-codes-20153\"> </a></td><td>Hematuria</td><td/></tr><tr><td style=\"white-space:nowrap\">20154<a name=\"example-referral-form-codes-20154\"> </a></td><td>Hydrocele, Varicocele or Spermatocele</td><td/></tr><tr><td style=\"white-space:nowrap\">20155<a name=\"example-referral-form-codes-20155\"> </a></td><td>Hydronephrosis</td><td/></tr><tr><td style=\"white-space:nowrap\">20156<a name=\"example-referral-form-codes-20156\"> </a></td><td>Hypogonadism</td><td/></tr><tr><td style=\"white-space:nowrap\">20157<a name=\"example-referral-form-codes-20157\"> </a></td><td>Infertility - Male</td><td/></tr><tr><td style=\"white-space:nowrap\">20158<a name=\"example-referral-form-codes-20158\"> </a></td><td>Penile Lesion</td><td/></tr><tr><td style=\"white-space:nowrap\">20159<a name=\"example-referral-form-codes-20159\"> </a></td><td>Peyronie's Disease</td><td/></tr><tr><td style=\"white-space:nowrap\">20160<a name=\"example-referral-form-codes-20160\"> </a></td><td>Phimosis, Foreskin Issue or Balanitis</td><td/></tr><tr><td style=\"white-space:nowrap\">20161<a name=\"example-referral-form-codes-20161\"> </a></td><td>Renal Mass or Cyst</td><td/></tr><tr><td style=\"white-space:nowrap\">20162<a name=\"example-referral-form-codes-20162\"> </a></td><td>Nephrolithiasis / Renal Colic</td><td/></tr><tr><td style=\"white-space:nowrap\">20163<a name=\"example-referral-form-codes-20163\"> </a></td><td>Testicular Mass</td><td/></tr><tr><td style=\"white-space:nowrap\">20164<a name=\"example-referral-form-codes-20164\"> </a></td><td>Urinary Incontinence or Overactive Bladder</td><td/></tr><tr><td style=\"white-space:nowrap\">20165<a name=\"example-referral-form-codes-20165\"> </a></td><td>Urinary Tract Infections - Recurrent</td><td/></tr><tr><td style=\"white-space:nowrap\">20166<a name=\"example-referral-form-codes-20166\"> </a></td><td>Vasectomy</td><td/></tr><tr><td style=\"white-space:nowrap\">20167<a name=\"example-referral-form-codes-20167\"> </a></td><td>Gross</td><td/></tr><tr><td style=\"white-space:nowrap\">20168<a name=\"example-referral-form-codes-20168\"> </a></td><td>Microscopic</td><td/></tr><tr><td style=\"white-space:nowrap\">20169<a name=\"example-referral-form-codes-20169\"> </a></td><td>Imaging demonstrates an obstructive stone</td><td/></tr><tr><td style=\"white-space:nowrap\">20170<a name=\"example-referral-form-codes-20170\"> </a></td><td>Neurodiagnostic Testing - Triage to Consult if Appropriate</td><td/></tr><tr><td style=\"white-space:nowrap\">20171<a name=\"example-referral-form-codes-20171\"> </a></td><td>Neurodiagnostic Testing Only (EEG, EMG/NCS)</td><td/></tr><tr><td style=\"white-space:nowrap\">20172<a name=\"example-referral-form-codes-20172\"> </a></td><td>Neurology Consultation</td><td/></tr><tr><td style=\"white-space:nowrap\">20173<a name=\"example-referral-form-codes-20173\"> </a></td><td>Electroencephalography (EEG)</td><td/></tr><tr><td style=\"white-space:nowrap\">20174<a name=\"example-referral-form-codes-20174\"> </a></td><td>Electromyography (EMG) / Nerve Conduction Study (NCS)</td><td/></tr><tr><td style=\"white-space:nowrap\">20175<a name=\"example-referral-form-codes-20175\"> </a></td><td>Routine EEG</td><td/></tr><tr><td style=\"white-space:nowrap\">20176<a name=\"example-referral-form-codes-20176\"> </a></td><td>Sleep Deprived EEG</td><td/></tr><tr><td style=\"white-space:nowrap\">20177<a name=\"example-referral-form-codes-20177\"> </a></td><td>Carpal Tunnel Syndrome</td><td/></tr><tr><td style=\"white-space:nowrap\">20178<a name=\"example-referral-form-codes-20178\"> </a></td><td>Cervical Radiculopathy</td><td/></tr><tr><td style=\"white-space:nowrap\">20179<a name=\"example-referral-form-codes-20179\"> </a></td><td>Lumbar Radiculopathy</td><td/></tr><tr><td style=\"white-space:nowrap\">20180<a name=\"example-referral-form-codes-20180\"> </a></td><td>Peripheral Neuropathy / Polyneuropathy</td><td/></tr><tr><td style=\"white-space:nowrap\">20181<a name=\"example-referral-form-codes-20181\"> </a></td><td>Balance, Dizziness, or Vertigo</td><td/></tr><tr><td style=\"white-space:nowrap\">20182<a name=\"example-referral-form-codes-20182\"> </a></td><td>Concussion or Traumatic Brain Injury (TBI)</td><td/></tr><tr><td style=\"white-space:nowrap\">20183<a name=\"example-referral-form-codes-20183\"> </a></td><td>Epilepsy or Seizure</td><td/></tr><tr><td style=\"white-space:nowrap\">20184<a name=\"example-referral-form-codes-20184\"> </a></td><td>Headache or Migraines</td><td/></tr><tr><td style=\"white-space:nowrap\">20185<a name=\"example-referral-form-codes-20185\"> </a></td><td>Movement Disorders (including Parkinson's and Tremors)</td><td/></tr><tr><td style=\"white-space:nowrap\">20186<a name=\"example-referral-form-codes-20186\"> </a></td><td>Multiple Sclerosis or Demyelinating Disease</td><td/></tr><tr><td style=\"white-space:nowrap\">20187<a name=\"example-referral-form-codes-20187\"> </a></td><td>Neurocognitive Disorder</td><td/></tr><tr><td style=\"white-space:nowrap\">20188<a name=\"example-referral-form-codes-20188\"> </a></td><td>Neuropathy or Weakness</td><td/></tr><tr><td style=\"white-space:nowrap\">20190<a name=\"example-referral-form-codes-20190\"> </a></td><td>Stroke or TIA</td><td/></tr><tr><td style=\"white-space:nowrap\">20191<a name=\"example-referral-form-codes-20191\"> </a></td><td>Crystal Arthropathies (Gout, Pseudogout)</td><td/></tr><tr><td style=\"white-space:nowrap\">20192<a name=\"example-referral-form-codes-20192\"> </a></td><td>Connective Tissue Diseases (Lupus, Sjogren's, Scleroderma, Inflammatory Myositis)</td><td/></tr><tr><td style=\"white-space:nowrap\">20193<a name=\"example-referral-form-codes-20193\"> </a></td><td>Corticosteroid Injections (Osteoarthritis / Tendinitis / Bursitis / Joint Injections)</td><td/></tr><tr><td style=\"white-space:nowrap\">20194<a name=\"example-referral-form-codes-20194\"> </a></td><td>Giant Cell Arteritis</td><td/></tr><tr><td style=\"white-space:nowrap\">20195<a name=\"example-referral-form-codes-20195\"> </a></td><td>Inflammatory Arthritis (e.g. Rheumatoid Arthritis)</td><td/></tr><tr><td style=\"white-space:nowrap\">20196<a name=\"example-referral-form-codes-20196\"> </a></td><td>Polymyalgia Rheumatica</td><td/></tr><tr><td style=\"white-space:nowrap\">20197<a name=\"example-referral-form-codes-20197\"> </a></td><td>Psoriatic Arthritis</td><td/></tr><tr><td style=\"white-space:nowrap\">20198<a name=\"example-referral-form-codes-20198\"> </a></td><td>Spondyloarthritis</td><td/></tr><tr><td style=\"white-space:nowrap\">20199<a name=\"example-referral-form-codes-20199\"> </a></td><td>Vasculitis</td><td/></tr><tr><td style=\"white-space:nowrap\">20200<a name=\"example-referral-form-codes-20200\"> </a></td><td>= 3 attacks in the last year</td><td/></tr><tr><td style=\"white-space:nowrap\">20201<a name=\"example-referral-form-codes-20201\"> </a></td><td>Alopecia / sicca / oral ulcers</td><td/></tr><tr><td style=\"white-space:nowrap\">20202<a name=\"example-referral-form-codes-20202\"> </a></td><td>Arterial / venous thrombosis</td><td/></tr><tr><td style=\"white-space:nowrap\">20203<a name=\"example-referral-form-codes-20203\"> </a></td><td>Glomerulonephritis</td><td/></tr><tr><td style=\"white-space:nowrap\">20204<a name=\"example-referral-form-codes-20204\"> </a></td><td>Hemolytic anemia / ITP</td><td/></tr><tr><td style=\"white-space:nowrap\">20205<a name=\"example-referral-form-codes-20205\"> </a></td><td>Inflammatory Arthritis</td><td/></tr><tr><td style=\"white-space:nowrap\">20207<a name=\"example-referral-form-codes-20207\"> </a></td><td>Objective proximal muscle weakness and high CK</td><td/></tr><tr><td style=\"white-space:nowrap\">20208<a name=\"example-referral-form-codes-20208\"> </a></td><td>Pericarditis / pleural effusions</td><td/></tr><tr><td style=\"white-space:nowrap\">20209<a name=\"example-referral-form-codes-20209\"> </a></td><td>Photosensitivity and rash</td><td/></tr><tr><td style=\"white-space:nowrap\">20210<a name=\"example-referral-form-codes-20210\"> </a></td><td>Pregnancy loss (recurrent)</td><td/></tr><tr><td style=\"white-space:nowrap\">20211<a name=\"example-referral-form-codes-20211\"> </a></td><td>Raynaud�s phenomenon</td><td/></tr><tr><td style=\"white-space:nowrap\">20212<a name=\"example-referral-form-codes-20212\"> </a></td><td>Sclerodactyly / puffy fingers</td><td/></tr><tr><td style=\"white-space:nowrap\">20213<a name=\"example-referral-form-codes-20213\"> </a></td><td>Referred for temporal artery biopsy or ultrasound</td><td/></tr><tr><td style=\"white-space:nowrap\">20214<a name=\"example-referral-form-codes-20214\"> </a></td><td>Vision loss or diplopia</td><td/></tr><tr><td style=\"white-space:nowrap\">20215<a name=\"example-referral-form-codes-20215\"> </a></td><td>New headache</td><td/></tr><tr><td style=\"white-space:nowrap\">20216<a name=\"example-referral-form-codes-20216\"> </a></td><td>Jaw claudication</td><td/></tr><tr><td style=\"white-space:nowrap\">20217<a name=\"example-referral-form-codes-20217\"> </a></td><td>Scalp tenderness</td><td/></tr><tr><td style=\"white-space:nowrap\">20218<a name=\"example-referral-form-codes-20218\"> </a></td><td>Significant weight loss or malaise</td><td/></tr><tr><td style=\"white-space:nowrap\">20219<a name=\"example-referral-form-codes-20219\"> </a></td><td>Unexplained dry cough</td><td/></tr><tr><td style=\"white-space:nowrap\">20220<a name=\"example-referral-form-codes-20220\"> </a></td><td>Ankylosing Spondylitis</td><td/></tr><tr><td style=\"white-space:nowrap\">20221<a name=\"example-referral-form-codes-20221\"> </a></td><td>Reactive Arthritis</td><td/></tr><tr><td style=\"white-space:nowrap\">20222<a name=\"example-referral-form-codes-20222\"> </a></td><td>IBD Related Arthritis</td><td/></tr><tr><td style=\"white-space:nowrap\">20223<a name=\"example-referral-form-codes-20223\"> </a></td><td>Contraception</td><td/></tr><tr><td style=\"white-space:nowrap\">20224<a name=\"example-referral-form-codes-20224\"> </a></td><td>Fertility and Infertility</td><td/></tr><tr><td style=\"white-space:nowrap\">20225<a name=\"example-referral-form-codes-20225\"> </a></td><td>Gynecology</td><td/></tr><tr><td style=\"white-space:nowrap\">20226<a name=\"example-referral-form-codes-20226\"> </a></td><td>Obstetrics (Routine)</td><td/></tr><tr><td style=\"white-space:nowrap\">20227<a name=\"example-referral-form-codes-20227\"> </a></td><td>Obstetrics (High Risk)</td><td/></tr><tr><td style=\"white-space:nowrap\">20228<a name=\"example-referral-form-codes-20228\"> </a></td><td>Pregnancy Termination</td><td/></tr><tr><td style=\"white-space:nowrap\">20229<a name=\"example-referral-form-codes-20229\"> </a></td><td>Transgender Care</td><td/></tr><tr><td style=\"white-space:nowrap\">20230<a name=\"example-referral-form-codes-20230\"> </a></td><td>Contraceptive Counselling</td><td/></tr><tr><td style=\"white-space:nowrap\">20231<a name=\"example-referral-form-codes-20231\"> </a></td><td>IUD Insertion</td><td/></tr><tr><td style=\"white-space:nowrap\">20232<a name=\"example-referral-form-codes-20232\"> </a></td><td>IUD Removal</td><td/></tr><tr><td style=\"white-space:nowrap\">20233<a name=\"example-referral-form-codes-20233\"> </a></td><td>Contraceptive Implant Insertion</td><td/></tr><tr><td style=\"white-space:nowrap\">20234<a name=\"example-referral-form-codes-20234\"> </a></td><td>Contraceptive Implant Removal</td><td/></tr><tr><td style=\"white-space:nowrap\">20235<a name=\"example-referral-form-codes-20235\"> </a></td><td>Fertility Status Evaluation</td><td/></tr><tr><td style=\"white-space:nowrap\">20236<a name=\"example-referral-form-codes-20236\"> </a></td><td>Recurrent Pregnancy Loss</td><td/></tr><tr><td style=\"white-space:nowrap\">20237<a name=\"example-referral-form-codes-20237\"> </a></td><td>Abnormal Cervical Cancer Screening</td><td/></tr><tr><td style=\"white-space:nowrap\">20238<a name=\"example-referral-form-codes-20238\"> </a></td><td>Abnormal Uterine Bleeding</td><td/></tr><tr><td style=\"white-space:nowrap\">20239<a name=\"example-referral-form-codes-20239\"> </a></td><td>Adnexal Mass or Cyst</td><td/></tr><tr><td style=\"white-space:nowrap\">20240<a name=\"example-referral-form-codes-20240\"> </a></td><td>Amenorrhea</td><td/></tr><tr><td style=\"white-space:nowrap\">20241<a name=\"example-referral-form-codes-20241\"> </a></td><td>Dyspareunia or Vaginismus</td><td/></tr><tr><td style=\"white-space:nowrap\">20242<a name=\"example-referral-form-codes-20242\"> </a></td><td>Early Pregnancy Loss or Complication</td><td/></tr><tr><td style=\"white-space:nowrap\">20243<a name=\"example-referral-form-codes-20243\"> </a></td><td>Endometriosis or Pelvic Pain</td><td/></tr><tr><td style=\"white-space:nowrap\">20244<a name=\"example-referral-form-codes-20244\"> </a></td><td>Menopause Management (including Hormone Replacement Therapy)</td><td/></tr><tr><td style=\"white-space:nowrap\">20245<a name=\"example-referral-form-codes-20245\"> </a></td><td>Pelvic Inflammatory Disease</td><td/></tr><tr><td style=\"white-space:nowrap\">20246<a name=\"example-referral-form-codes-20246\"> </a></td><td>Polycystic Ovarian Syndrome (PCOS)</td><td/></tr><tr><td style=\"white-space:nowrap\">20247<a name=\"example-referral-form-codes-20247\"> </a></td><td>Post-Menopausal Bleeding</td><td/></tr><tr><td style=\"white-space:nowrap\">20248<a name=\"example-referral-form-codes-20248\"> </a></td><td>Pelvic Organ Prolapse or Pessary Management</td><td/></tr><tr><td style=\"white-space:nowrap\">20249<a name=\"example-referral-form-codes-20249\"> </a></td><td>Urinary Incontinence</td><td/></tr><tr><td style=\"white-space:nowrap\">20250<a name=\"example-referral-form-codes-20250\"> </a></td><td>Uterine Fibroids, Polyps, Septum, or Other Structural Abnormalities</td><td/></tr><tr><td style=\"white-space:nowrap\">20251<a name=\"example-referral-form-codes-20251\"> </a></td><td>Vaginitis</td><td/></tr><tr><td style=\"white-space:nowrap\">20252<a name=\"example-referral-form-codes-20252\"> </a></td><td>Vulvar, Vaginal, or Cervical Disorders</td><td/></tr><tr><td style=\"white-space:nowrap\">20253<a name=\"example-referral-form-codes-20253\"> </a></td><td>Total Antenatal Care</td><td/></tr><tr><td style=\"white-space:nowrap\">20254<a name=\"example-referral-form-codes-20254\"> </a></td><td>Shared Antenatal Care</td><td/></tr><tr><td style=\"white-space:nowrap\">20255<a name=\"example-referral-form-codes-20255\"> </a></td><td>Obstetrical Consult</td><td/></tr><tr><td style=\"white-space:nowrap\">20256<a name=\"example-referral-form-codes-20256\"> </a></td><td>Last Menstrual Period (LMP)</td><td/></tr><tr><td style=\"white-space:nowrap\">20257<a name=\"example-referral-form-codes-20257\"> </a></td><td>Estimated Date of Delivery (EDD)</td><td/></tr><tr><td style=\"white-space:nowrap\">20258<a name=\"example-referral-form-codes-20258\"> </a></td><td>GTPAL</td><td/></tr><tr><td style=\"white-space:nowrap\">20259<a name=\"example-referral-form-codes-20259\"> </a></td><td>Abnormal Prenatal Screen</td><td/></tr><tr><td style=\"white-space:nowrap\">20260<a name=\"example-referral-form-codes-20260\"> </a></td><td>Congenital Abnormalities</td><td/></tr><tr><td style=\"white-space:nowrap\">20261<a name=\"example-referral-form-codes-20261\"> </a></td><td>Diabetes (pre-existing)</td><td/></tr><tr><td style=\"white-space:nowrap\">20262<a name=\"example-referral-form-codes-20262\"> </a></td><td>Gestational Diabetes</td><td/></tr><tr><td style=\"white-space:nowrap\">20263<a name=\"example-referral-form-codes-20263\"> </a></td><td>HIV Pregnancy</td><td/></tr><tr><td style=\"white-space:nowrap\">20265<a name=\"example-referral-form-codes-20265\"> </a></td><td>Infectious Disease</td><td/></tr><tr><td style=\"white-space:nowrap\">20266<a name=\"example-referral-form-codes-20266\"> </a></td><td>Intrauterine Growth Restriction</td><td/></tr><tr><td style=\"white-space:nowrap\">20267<a name=\"example-referral-form-codes-20267\"> </a></td><td>Medical Disease in Pregnancy</td><td/></tr><tr><td style=\"white-space:nowrap\">20268<a name=\"example-referral-form-codes-20268\"> </a></td><td>Multiple Gestation (Twins, Triplets, Higher Order)</td><td/></tr><tr><td style=\"white-space:nowrap\">20269<a name=\"example-referral-form-codes-20269\"> </a></td><td>Placental Abnormalities</td><td/></tr><tr><td style=\"white-space:nowrap\">20270<a name=\"example-referral-form-codes-20270\"> </a></td><td>Pre-Conception Counselling</td><td/></tr><tr><td style=\"white-space:nowrap\">20271<a name=\"example-referral-form-codes-20271\"> </a></td><td>Substance Abuse in Pregnancy</td><td/></tr><tr><td style=\"white-space:nowrap\">20272<a name=\"example-referral-form-codes-20272\"> </a></td><td>Current gestational age</td><td/></tr><tr><td style=\"white-space:nowrap\">20273<a name=\"example-referral-form-codes-20273\"> </a></td><td>Bicytopenia or Pancytopenia (decreases in more than one cell line)</td><td/></tr><tr><td style=\"white-space:nowrap\">20274<a name=\"example-referral-form-codes-20274\"> </a></td><td>Bleeding or Abnormal INR/PTT</td><td/></tr><tr><td style=\"white-space:nowrap\">20275<a name=\"example-referral-form-codes-20275\"> </a></td><td>Confirmed Malignant Hematology Consultation (biopsy proven)</td><td/></tr><tr><td style=\"white-space:nowrap\">20276<a name=\"example-referral-form-codes-20276\"> </a></td><td>Red Blood Cells or Iron</td><td/></tr><tr><td style=\"white-space:nowrap\">20277<a name=\"example-referral-form-codes-20277\"> </a></td><td>Myeloma or Paraproteinemia (e.g. Bence Jones proteinuria, monoclonal gammopathy)</td><td/></tr><tr><td style=\"white-space:nowrap\">20278<a name=\"example-referral-form-codes-20278\"> </a></td><td>Lymph Nodes or Spleen</td><td/></tr><tr><td style=\"white-space:nowrap\">20279<a name=\"example-referral-form-codes-20279\"> </a></td><td>Platelets</td><td/></tr><tr><td style=\"white-space:nowrap\">20280<a name=\"example-referral-form-codes-20280\"> </a></td><td>Thrombosis</td><td/></tr><tr><td style=\"white-space:nowrap\">20281<a name=\"example-referral-form-codes-20281\"> </a></td><td>Transfusion</td><td/></tr><tr><td style=\"white-space:nowrap\">20282<a name=\"example-referral-form-codes-20282\"> </a></td><td>White Blood Cells</td><td/></tr><tr><td style=\"white-space:nowrap\">20283<a name=\"example-referral-form-codes-20283\"> </a></td><td>Other Benign Hematology Consultation</td><td/></tr><tr><td style=\"white-space:nowrap\">20284<a name=\"example-referral-form-codes-20284\"> </a></td><td>Other Malignant Hematology Consultation</td><td/></tr><tr><td style=\"white-space:nowrap\">20285<a name=\"example-referral-form-codes-20285\"> </a></td><td>Labs abnormal - no bleeding / bruising</td><td/></tr><tr><td style=\"white-space:nowrap\">20286<a name=\"example-referral-form-codes-20286\"> </a></td><td>Abnormal bleeding / bruising</td><td/></tr><tr><td style=\"white-space:nowrap\">20287<a name=\"example-referral-form-codes-20287\"> </a></td><td>Anemia NYD</td><td/></tr><tr><td style=\"white-space:nowrap\">20288<a name=\"example-referral-form-codes-20288\"> </a></td><td>Anemia - Iron Deficiency</td><td/></tr><tr><td style=\"white-space:nowrap\">20289<a name=\"example-referral-form-codes-20289\"> </a></td><td>Erythrocytosis</td><td/></tr><tr><td style=\"white-space:nowrap\">20290<a name=\"example-referral-form-codes-20290\"> </a></td><td>Ferritin - High</td><td/></tr><tr><td style=\"white-space:nowrap\">20291<a name=\"example-referral-form-codes-20291\"> </a></td><td>Hemoglobinopathy</td><td/></tr><tr><td style=\"white-space:nowrap\">20292<a name=\"example-referral-form-codes-20292\"> </a></td><td>Sickle Cell Disease</td><td/></tr><tr><td style=\"white-space:nowrap\">20293<a name=\"example-referral-form-codes-20293\"> </a></td><td>Thallasemias</td><td/></tr><tr><td style=\"white-space:nowrap\">20294<a name=\"example-referral-form-codes-20294\"> </a></td><td>Other Hemoglobinopathy</td><td/></tr><tr><td style=\"white-space:nowrap\">20295<a name=\"example-referral-form-codes-20295\"> </a></td><td>Lymphadenopathy - Concern for Lymphoma</td><td/></tr><tr><td style=\"white-space:nowrap\">20296<a name=\"example-referral-form-codes-20296\"> </a></td><td>Lymphoma</td><td/></tr><tr><td style=\"white-space:nowrap\">20297<a name=\"example-referral-form-codes-20297\"> </a></td><td>Splenomegaly</td><td/></tr><tr><td style=\"white-space:nowrap\">20298<a name=\"example-referral-form-codes-20298\"> </a></td><td>Thrombocytopenia (low platelets)</td><td/></tr><tr><td style=\"white-space:nowrap\">20299<a name=\"example-referral-form-codes-20299\"> </a></td><td>Thrombocytosis (high platelets)</td><td/></tr><tr><td style=\"white-space:nowrap\">20300<a name=\"example-referral-form-codes-20300\"> </a></td><td>Atrial Fibrillation Anticoagulation</td><td/></tr><tr><td style=\"white-space:nowrap\">20301<a name=\"example-referral-form-codes-20301\"> </a></td><td>Mechanical Valve Anticoagulation</td><td/></tr><tr><td style=\"white-space:nowrap\">20302<a name=\"example-referral-form-codes-20302\"> </a></td><td>Peripartum Thrombosis - Prevention or Treatment</td><td/></tr><tr><td style=\"white-space:nowrap\">20303<a name=\"example-referral-form-codes-20303\"> </a></td><td>Peri-procedure Anticoagulation Management</td><td/></tr><tr><td style=\"white-space:nowrap\">20304<a name=\"example-referral-form-codes-20304\"> </a></td><td>Superficial Vein Thrombosis</td><td/></tr><tr><td style=\"white-space:nowrap\">20305<a name=\"example-referral-form-codes-20305\"> </a></td><td>Thrombophilia</td><td/></tr><tr><td style=\"white-space:nowrap\">20306<a name=\"example-referral-form-codes-20306\"> </a></td><td>Venous Thromboembolism - Acute - Imaging Confirmed (e.g. DVT, PE)</td><td/></tr><tr><td style=\"white-space:nowrap\">20307<a name=\"example-referral-form-codes-20307\"> </a></td><td>Venous Thromboembolism - Chronic (e.g. DVT, PE)</td><td/></tr><tr><td style=\"white-space:nowrap\">20308<a name=\"example-referral-form-codes-20308\"> </a></td><td>Other Thrombosis Consultation</td><td/></tr><tr><td style=\"white-space:nowrap\">20309<a name=\"example-referral-form-codes-20309\"> </a></td><td>Acute Leukemia (myeloid or lymphoblastic)</td><td/></tr><tr><td style=\"white-space:nowrap\">20310<a name=\"example-referral-form-codes-20310\"> </a></td><td>Chronic Leukemia (myeloid or lymphoblastic)</td><td/></tr><tr><td style=\"white-space:nowrap\">20311<a name=\"example-referral-form-codes-20311\"> </a></td><td>Leukocytosis (high white blood cells)</td><td/></tr><tr><td style=\"white-space:nowrap\">20312<a name=\"example-referral-form-codes-20312\"> </a></td><td>Leukopenia (low white blood cells, including low neutrophil count)</td><td/></tr><tr><td style=\"white-space:nowrap\">20313<a name=\"example-referral-form-codes-20313\"> </a></td><td>Acute Kidney Injury (AKI)</td><td/></tr><tr><td style=\"white-space:nowrap\">20314<a name=\"example-referral-form-codes-20314\"> </a></td><td>Chronic Kidney Disease (CKD)</td><td/></tr><tr><td style=\"white-space:nowrap\">20315<a name=\"example-referral-form-codes-20315\"> </a></td><td>Electrolyte Disorders</td><td/></tr><tr><td style=\"white-space:nowrap\">20318<a name=\"example-referral-form-codes-20318\"> </a></td><td>Imaging Abnormalities</td><td/></tr><tr><td style=\"white-space:nowrap\">20319<a name=\"example-referral-form-codes-20319\"> </a></td><td>Kidney Stones</td><td/></tr><tr><td style=\"white-space:nowrap\">20320<a name=\"example-referral-form-codes-20320\"> </a></td><td>Proteinuria</td><td/></tr><tr><td style=\"white-space:nowrap\">20321<a name=\"example-referral-form-codes-20321\"> </a></td><td>Suspected Glomerulonephritis/Renal Vasculitis</td><td/></tr><tr><td style=\"white-space:nowrap\">20322<a name=\"example-referral-form-codes-20322\"> </a></td><td>Rapidly worsening kidney function, confirmed on repeat testing in absence of remediable causes</td><td/></tr><tr><td style=\"white-space:nowrap\">20323<a name=\"example-referral-form-codes-20323\"> </a></td><td>ACR = 60 � Persistent for = 3 months</td><td/></tr><tr><td style=\"white-space:nowrap\">20324<a name=\"example-referral-form-codes-20324\"> </a></td><td>eGFR &lt; 30 � Persistent for = 3 months</td><td/></tr><tr><td style=\"white-space:nowrap\">20325<a name=\"example-referral-form-codes-20325\"> </a></td><td>eGFR &lt; 45 and confirmed decline of = 5 within 6 months</td><td/></tr><tr><td style=\"white-space:nowrap\">20326<a name=\"example-referral-form-codes-20326\"> </a></td><td>eGFR &lt; 45 and age = 50 without CKD risk factors</td><td/></tr><tr><td style=\"white-space:nowrap\">20327<a name=\"example-referral-form-codes-20327\"> </a></td><td>5-year KFRE = 5%</td><td/></tr><tr><td style=\"white-space:nowrap\">20328<a name=\"example-referral-form-codes-20328\"> </a></td><td>Gross (suggest Urology referral first for those &gt; 40 years of age)</td><td/></tr><tr><td style=\"white-space:nowrap\">20329<a name=\"example-referral-form-codes-20329\"> </a></td><td>Microscopic &gt; 10 RBC/hpf - confirmed by microscopy</td><td/></tr><tr><td style=\"white-space:nowrap\">20330<a name=\"example-referral-form-codes-20330\"> </a></td><td>Resistant</td><td/></tr><tr><td style=\"white-space:nowrap\">20331<a name=\"example-referral-form-codes-20331\"> </a></td><td>Suspected Secondary Hypertension</td><td/></tr><tr><td style=\"white-space:nowrap\">20332<a name=\"example-referral-form-codes-20332\"> </a></td><td>Multicystic / Polycystic kidneys</td><td/></tr><tr><td style=\"white-space:nowrap\">20333<a name=\"example-referral-form-codes-20333\"> </a></td><td>Shrunken / Atrophic kidney</td><td/></tr><tr><td style=\"white-space:nowrap\">20334<a name=\"example-referral-form-codes-20334\"> </a></td><td>Metabolic work-up for recurrent stones</td><td/></tr><tr><td style=\"white-space:nowrap\">20335<a name=\"example-referral-form-codes-20335\"> </a></td><td>ACR = 30 without Diabetes Mellitus � Persistent for = 3 months</td><td/></tr><tr><td style=\"white-space:nowrap\">20336<a name=\"example-referral-form-codes-20336\"> </a></td><td>24-hour urine protein = 1 g</td><td/></tr><tr><td style=\"white-space:nowrap\">20337<a name=\"example-referral-form-codes-20337\"> </a></td><td>Hematuria with = 10 RBC/hpf � Confirmed by microscopy</td><td/></tr><tr><td style=\"white-space:nowrap\">20338<a name=\"example-referral-form-codes-20338\"> </a></td><td>Urine ACR</td><td/></tr><tr><td style=\"white-space:nowrap\">20339<a name=\"example-referral-form-codes-20339\"> </a></td><td>eGFR</td><td/></tr><tr><td style=\"white-space:nowrap\">20340<a name=\"example-referral-form-codes-20340\"> </a></td><td>Potassium</td><td/></tr><tr><td style=\"white-space:nowrap\">20341<a name=\"example-referral-form-codes-20341\"> </a></td><td>Shoulder</td><td/></tr><tr><td style=\"white-space:nowrap\">20342<a name=\"example-referral-form-codes-20342\"> </a></td><td>Arm</td><td/></tr><tr><td style=\"white-space:nowrap\">20343<a name=\"example-referral-form-codes-20343\"> </a></td><td>Elbow</td><td/></tr><tr><td style=\"white-space:nowrap\">20344<a name=\"example-referral-form-codes-20344\"> </a></td><td>Forearm</td><td/></tr><tr><td style=\"white-space:nowrap\">20345<a name=\"example-referral-form-codes-20345\"> </a></td><td>Wrist</td><td/></tr><tr><td style=\"white-space:nowrap\">20346<a name=\"example-referral-form-codes-20346\"> </a></td><td>Hand</td><td/></tr><tr><td style=\"white-space:nowrap\">20347<a name=\"example-referral-form-codes-20347\"> </a></td><td>Spine</td><td/></tr><tr><td style=\"white-space:nowrap\">20348<a name=\"example-referral-form-codes-20348\"> </a></td><td>Pelvis</td><td/></tr><tr><td style=\"white-space:nowrap\">20349<a name=\"example-referral-form-codes-20349\"> </a></td><td>Hip</td><td/></tr><tr><td style=\"white-space:nowrap\">20350<a name=\"example-referral-form-codes-20350\"> </a></td><td>Thigh</td><td/></tr><tr><td style=\"white-space:nowrap\">20351<a name=\"example-referral-form-codes-20351\"> </a></td><td>Knee</td><td/></tr><tr><td style=\"white-space:nowrap\">20352<a name=\"example-referral-form-codes-20352\"> </a></td><td>Leg</td><td/></tr><tr><td style=\"white-space:nowrap\">20353<a name=\"example-referral-form-codes-20353\"> </a></td><td>Ankle / Hindfoot</td><td/></tr><tr><td style=\"white-space:nowrap\">20354<a name=\"example-referral-form-codes-20354\"> </a></td><td>Midfoot / Forefoot</td><td/></tr><tr><td style=\"white-space:nowrap\">20355<a name=\"example-referral-form-codes-20355\"> </a></td><td>Fracture</td><td/></tr><tr><td style=\"white-space:nowrap\">20356<a name=\"example-referral-form-codes-20356\"> </a></td><td>Joint Instability / Subluxation</td><td/></tr><tr><td style=\"white-space:nowrap\">20357<a name=\"example-referral-form-codes-20357\"> </a></td><td>Osteoarthritis</td><td/></tr><tr><td style=\"white-space:nowrap\">20358<a name=\"example-referral-form-codes-20358\"> </a></td><td>Pain NYD</td><td/></tr><tr><td style=\"white-space:nowrap\">20359<a name=\"example-referral-form-codes-20359\"> </a></td><td>Rotator Cuff / Impingement</td><td/></tr><tr><td style=\"white-space:nowrap\">20360<a name=\"example-referral-form-codes-20360\"> </a></td><td>Post-traumatic arthritis</td><td/></tr><tr><td style=\"white-space:nowrap\">20362<a name=\"example-referral-form-codes-20362\"> </a></td><td>De Quervain�s Tenosynovitis</td><td/></tr><tr><td style=\"white-space:nowrap\">20363<a name=\"example-referral-form-codes-20363\"> </a></td><td>Ganglion Cyst</td><td/></tr><tr><td style=\"white-space:nowrap\">20364<a name=\"example-referral-form-codes-20364\"> </a></td><td>Dupuytren�s Contracture</td><td/></tr><tr><td style=\"white-space:nowrap\">20365<a name=\"example-referral-form-codes-20365\"> </a></td><td>Finger Deformity</td><td/></tr><tr><td style=\"white-space:nowrap\">20366<a name=\"example-referral-form-codes-20366\"> </a></td><td>Flexor Tendon Injury</td><td/></tr><tr><td style=\"white-space:nowrap\">20367<a name=\"example-referral-form-codes-20367\"> </a></td><td>Trigger Finger</td><td/></tr><tr><td style=\"white-space:nowrap\">20368<a name=\"example-referral-form-codes-20368\"> </a></td><td>Cervical Spine</td><td/></tr><tr><td style=\"white-space:nowrap\">20369<a name=\"example-referral-form-codes-20369\"> </a></td><td>Thoracic Spine</td><td/></tr><tr><td style=\"white-space:nowrap\">20370<a name=\"example-referral-form-codes-20370\"> </a></td><td>Lumbar Spine</td><td/></tr><tr><td style=\"white-space:nowrap\">20371<a name=\"example-referral-form-codes-20371\"> </a></td><td>Deformity / Scoliosis / Kyphosis</td><td/></tr><tr><td style=\"white-space:nowrap\">20372<a name=\"example-referral-form-codes-20372\"> </a></td><td>Myelopathy</td><td/></tr><tr><td style=\"white-space:nowrap\">20373<a name=\"example-referral-form-codes-20373\"> </a></td><td>Neurogenic Claudication</td><td/></tr><tr><td style=\"white-space:nowrap\">20374<a name=\"example-referral-form-codes-20374\"> </a></td><td>Spondylolisthesis</td><td/></tr><tr><td style=\"white-space:nowrap\">20375<a name=\"example-referral-form-codes-20375\"> </a></td><td>Stenosis</td><td/></tr><tr><td style=\"white-space:nowrap\">20377<a name=\"example-referral-form-codes-20377\"> </a></td><td>ACL Tear</td><td/></tr><tr><td style=\"white-space:nowrap\">20378<a name=\"example-referral-form-codes-20378\"> </a></td><td>Cartilage Injury</td><td/></tr><tr><td style=\"white-space:nowrap\">20376<a name=\"example-referral-form-codes-20376\"> </a></td><td>Knee Malalignment</td><td/></tr><tr><td style=\"white-space:nowrap\">20379<a name=\"example-referral-form-codes-20379\"> </a></td><td>Loose Bodies</td><td/></tr><tr><td style=\"white-space:nowrap\">20380<a name=\"example-referral-form-codes-20380\"> </a></td><td>Meniscal Tear</td><td/></tr><tr><td style=\"white-space:nowrap\">20381<a name=\"example-referral-form-codes-20381\"> </a></td><td>Multi-Ligament Injury</td><td/></tr><tr><td style=\"white-space:nowrap\">20382<a name=\"example-referral-form-codes-20382\"> </a></td><td>Achilles Tendinopathy</td><td/></tr><tr><td style=\"white-space:nowrap\">20383<a name=\"example-referral-form-codes-20383\"> </a></td><td>Joint Instability</td><td/></tr><tr><td style=\"white-space:nowrap\">20384<a name=\"example-referral-form-codes-20384\"> </a></td><td>Bunion</td><td/></tr><tr><td style=\"white-space:nowrap\">20385<a name=\"example-referral-form-codes-20385\"> </a></td><td>Charcot Foot</td><td/></tr><tr><td style=\"white-space:nowrap\">20386<a name=\"example-referral-form-codes-20386\"> </a></td><td>Flatfoot / Pes Planus</td><td/></tr><tr><td style=\"white-space:nowrap\">20387<a name=\"example-referral-form-codes-20387\"> </a></td><td>Metatarsalgia</td><td/></tr><tr><td style=\"white-space:nowrap\">20388<a name=\"example-referral-form-codes-20388\"> </a></td><td>Plantar Fasciitis</td><td/></tr><tr><td style=\"white-space:nowrap\">20389<a name=\"example-referral-form-codes-20389\"> </a></td><td>Toe Deformity</td><td/></tr><tr><td style=\"white-space:nowrap\">20390<a name=\"example-referral-form-codes-20390\"> </a></td><td>CT Requisition</td><td>Demande de TDM</td></tr><tr><td style=\"white-space:nowrap\">20391<a name=\"example-referral-form-codes-20391\"> </a></td><td>MRI Requisition</td><td>Demande d'IRM</td></tr><tr><td style=\"white-space:nowrap\">20392<a name=\"example-referral-form-codes-20392\"> </a></td><td>X-Ray Requisition</td><td>Demande de radiographie</td></tr><tr><td style=\"white-space:nowrap\">20393<a name=\"example-referral-form-codes-20393\"> </a></td><td>Ultrasound Requisition</td><td>Demande d'échographie</td></tr><tr><td style=\"white-space:nowrap\">20394<a name=\"example-referral-form-codes-20394\"> </a></td><td>Bone Mineral Density Requisition</td><td>Demande de densitométrie osseuse</td></tr><tr><td style=\"white-space:nowrap\">20395<a name=\"example-referral-form-codes-20395\"> </a></td><td>Head</td><td>Tête</td></tr><tr><td style=\"white-space:nowrap\">20396<a name=\"example-referral-form-codes-20396\"> </a></td><td>Neck</td><td>Cou</td></tr><tr><td style=\"white-space:nowrap\">20397<a name=\"example-referral-form-codes-20397\"> </a></td><td>Spine</td><td>Colonne vertébrale</td></tr><tr><td style=\"white-space:nowrap\">20398<a name=\"example-referral-form-codes-20398\"> </a></td><td>Thorax</td><td>Thorax</td></tr><tr><td style=\"white-space:nowrap\">20399<a name=\"example-referral-form-codes-20399\"> </a></td><td>Abdomen Pelvis</td><td>Abdomen Bassin</td></tr><tr><td style=\"white-space:nowrap\">20400<a name=\"example-referral-form-codes-20400\"> </a></td><td>Musculoskeletal</td><td>Musculosquelettique</td></tr><tr><td style=\"white-space:nowrap\">20401<a name=\"example-referral-form-codes-20401\"> </a></td><td>Angiography</td><td>Angiographie</td></tr><tr><td style=\"white-space:nowrap\">20403<a name=\"example-referral-form-codes-20403\"> </a></td><td>Whole-Body Low-Dose (Myeloma)</td><td>Corps entier faible dose (Myélome)</td></tr><tr><td style=\"white-space:nowrap\">20404<a name=\"example-referral-form-codes-20404\"> </a></td><td>Cardiac</td><td>Cardiaque</td></tr><tr><td style=\"white-space:nowrap\">20405<a name=\"example-referral-form-codes-20405\"> </a></td><td>Biopsy</td><td>Biopsie</td></tr><tr><td style=\"white-space:nowrap\">20406<a name=\"example-referral-form-codes-20406\"> </a></td><td>Brain</td><td>Cerveau</td></tr><tr><td style=\"white-space:nowrap\">20408<a name=\"example-referral-form-codes-20408\"> </a></td><td>Facial bones</td><td>Os du visage</td></tr><tr><td style=\"white-space:nowrap\">20409<a name=\"example-referral-form-codes-20409\"> </a></td><td>Internal auditory canals</td><td>Canaux auditifs internes</td></tr><tr><td style=\"white-space:nowrap\">20410<a name=\"example-referral-form-codes-20410\"> </a></td><td>Orbits</td><td>Orbites</td></tr><tr><td style=\"white-space:nowrap\">20411<a name=\"example-referral-form-codes-20411\"> </a></td><td>Sinuses</td><td>Sinus</td></tr><tr><td style=\"white-space:nowrap\">20412<a name=\"example-referral-form-codes-20412\"> </a></td><td>Temporal bones</td><td>Os temporaux</td></tr><tr><td style=\"white-space:nowrap\">20414<a name=\"example-referral-form-codes-20414\"> </a></td><td>Soft Tissue Neck</td><td>Tissus mous du cou</td></tr><tr><td style=\"white-space:nowrap\">20415<a name=\"example-referral-form-codes-20415\"> </a></td><td>Cervical Spine</td><td>Colonne cervicale</td></tr><tr><td style=\"white-space:nowrap\">20416<a name=\"example-referral-form-codes-20416\"> </a></td><td>Thoracic Spine</td><td>Colonne thoracique</td></tr><tr><td style=\"white-space:nowrap\">20417<a name=\"example-referral-form-codes-20417\"> </a></td><td>Lumbar Spine</td><td>Colonne lombaire</td></tr><tr><td style=\"white-space:nowrap\">20418<a name=\"example-referral-form-codes-20418\"> </a></td><td>Sacrum/Coccyx</td><td>Sacrum/Coccyx</td></tr><tr><td style=\"white-space:nowrap\">20419<a name=\"example-referral-form-codes-20419\"> </a></td><td>Sacroiliac Joints</td><td>Articulations sacro-iliaques</td></tr><tr><td style=\"white-space:nowrap\">20420<a name=\"example-referral-form-codes-20420\"> </a></td><td>Chest</td><td>Thorax</td></tr><tr><td style=\"white-space:nowrap\">20421<a name=\"example-referral-form-codes-20421\"> </a></td><td>Chest High Resolution</td><td>Thorax haute résolution</td></tr><tr><td style=\"white-space:nowrap\">20422<a name=\"example-referral-form-codes-20422\"> </a></td><td>Chest Low-Dose</td><td>Thorax faible dose</td></tr><tr><td style=\"white-space:nowrap\">20423<a name=\"example-referral-form-codes-20423\"> </a></td><td>Pulmonary Embolism</td><td>Embolie pulmonaire</td></tr><tr><td style=\"white-space:nowrap\">20425<a name=\"example-referral-form-codes-20425\"> </a></td><td>Thoracic Outlet</td><td>Défilé thoracique</td></tr><tr><td style=\"white-space:nowrap\">20426<a name=\"example-referral-form-codes-20426\"> </a></td><td>Chest Abdomen Pelvis</td><td>Thorax Abdomen Bassin</td></tr><tr><td style=\"white-space:nowrap\">20427<a name=\"example-referral-form-codes-20427\"> </a></td><td>Abdomen only</td><td>Abdomen seulement</td></tr><tr><td style=\"white-space:nowrap\">20428<a name=\"example-referral-form-codes-20428\"> </a></td><td>Pelvis only</td><td>Bassin seulement</td></tr><tr><td style=\"white-space:nowrap\">20430<a name=\"example-referral-form-codes-20430\"> </a></td><td>Colonography</td><td>Colonographie</td></tr><tr><td style=\"white-space:nowrap\">20431<a name=\"example-referral-form-codes-20431\"> </a></td><td>Enterography</td><td>Entérographie</td></tr><tr><td style=\"white-space:nowrap\">20432<a name=\"example-referral-form-codes-20432\"> </a></td><td>Renal Colic</td><td>Colique rénale</td></tr><tr><td style=\"white-space:nowrap\">20433<a name=\"example-referral-form-codes-20433\"> </a></td><td>Urography</td><td>Urographie</td></tr><tr><td style=\"white-space:nowrap\">20434<a name=\"example-referral-form-codes-20434\"> </a></td><td>Shoulder</td><td>Épaule</td></tr><tr><td style=\"white-space:nowrap\">20435<a name=\"example-referral-form-codes-20435\"> </a></td><td>Humerus</td><td>Humérus</td></tr><tr><td style=\"white-space:nowrap\">20436<a name=\"example-referral-form-codes-20436\"> </a></td><td>Elbow</td><td>Coude</td></tr><tr><td style=\"white-space:nowrap\">20437<a name=\"example-referral-form-codes-20437\"> </a></td><td>Forearm</td><td>Avant-bras</td></tr><tr><td style=\"white-space:nowrap\">20438<a name=\"example-referral-form-codes-20438\"> </a></td><td>Wrist</td><td>Poignet</td></tr><tr><td style=\"white-space:nowrap\">20439<a name=\"example-referral-form-codes-20439\"> </a></td><td>Hand</td><td>Main</td></tr><tr><td style=\"white-space:nowrap\">20440<a name=\"example-referral-form-codes-20440\"> </a></td><td>Bony Pelvis</td><td>Bassin osseux</td></tr><tr><td style=\"white-space:nowrap\">20441<a name=\"example-referral-form-codes-20441\"> </a></td><td>Hip</td><td>Hanche</td></tr><tr><td style=\"white-space:nowrap\">20442<a name=\"example-referral-form-codes-20442\"> </a></td><td>Femur</td><td>Fémur</td></tr><tr><td style=\"white-space:nowrap\">20443<a name=\"example-referral-form-codes-20443\"> </a></td><td>Knee</td><td>Genou</td></tr><tr><td style=\"white-space:nowrap\">20444<a name=\"example-referral-form-codes-20444\"> </a></td><td>Tibia and Fibula</td><td>Tibia et fibula</td></tr><tr><td style=\"white-space:nowrap\">20445<a name=\"example-referral-form-codes-20445\"> </a></td><td>Ankle</td><td>Cheville</td></tr><tr><td style=\"white-space:nowrap\">20446<a name=\"example-referral-form-codes-20446\"> </a></td><td>Foot</td><td>Pied</td></tr><tr><td style=\"white-space:nowrap\">20447<a name=\"example-referral-form-codes-20447\"> </a></td><td>Head Angiography</td><td>Angiographie de la tête</td></tr><tr><td style=\"white-space:nowrap\">20448<a name=\"example-referral-form-codes-20448\"> </a></td><td>Neck Angiography</td><td>Angiographie du cou</td></tr><tr><td style=\"white-space:nowrap\">20449<a name=\"example-referral-form-codes-20449\"> </a></td><td>Chest Angiography</td><td>Angiographie du thorax</td></tr><tr><td style=\"white-space:nowrap\">20450<a name=\"example-referral-form-codes-20450\"> </a></td><td>Chest Abdomen Pelvis Angiography</td><td>Angiographie thorax abdomen bassin</td></tr><tr><td style=\"white-space:nowrap\">20451<a name=\"example-referral-form-codes-20451\"> </a></td><td>Abdomen Angiography</td><td>Angiographie de l'abdomen</td></tr><tr><td style=\"white-space:nowrap\">20452<a name=\"example-referral-form-codes-20452\"> </a></td><td>Abdomen Pelvis Angiography</td><td>Angiographie abdomen bassin</td></tr><tr><td style=\"white-space:nowrap\">20453<a name=\"example-referral-form-codes-20453\"> </a></td><td>Pelvis Angiography</td><td>Angiographie du bassin</td></tr><tr><td style=\"white-space:nowrap\">20454<a name=\"example-referral-form-codes-20454\"> </a></td><td>Upper Extremity Angiography</td><td>Angiographie des membres supérieurs</td></tr><tr><td style=\"white-space:nowrap\">20455<a name=\"example-referral-form-codes-20455\"> </a></td><td>Lower Extremity Angiography</td><td>Angiographie des membres inférieurs</td></tr><tr><td style=\"white-space:nowrap\">20456<a name=\"example-referral-form-codes-20456\"> </a></td><td>Head Venography</td><td>Céphalique veineuse</td></tr><tr><td style=\"white-space:nowrap\">20464<a name=\"example-referral-form-codes-20464\"> </a></td><td>Cardiac CT</td><td>CT cardiaque</td></tr><tr><td style=\"white-space:nowrap\">20465<a name=\"example-referral-form-codes-20465\"> </a></td><td>Coronary Angiography (CCTA)</td><td>Angiographie coronarienne (CCTA)</td></tr><tr><td style=\"white-space:nowrap\">20466<a name=\"example-referral-form-codes-20466\"> </a></td><td>Cardiac Calcium Score</td><td>Score calcique cardiaque</td></tr><tr><td style=\"white-space:nowrap\">20467<a name=\"example-referral-form-codes-20467\"> </a></td><td>Head</td><td>Tête</td></tr><tr><td style=\"white-space:nowrap\">20468<a name=\"example-referral-form-codes-20468\"> </a></td><td>Neck</td><td>Cou</td></tr><tr><td style=\"white-space:nowrap\">20469<a name=\"example-referral-form-codes-20469\"> </a></td><td>Spine</td><td>Colonne vertébrale</td></tr><tr><td style=\"white-space:nowrap\">20470<a name=\"example-referral-form-codes-20470\"> </a></td><td>Thorax</td><td>Thorax</td></tr><tr><td style=\"white-space:nowrap\">20471<a name=\"example-referral-form-codes-20471\"> </a></td><td>Abdomen</td><td>Abdomen</td></tr><tr><td style=\"white-space:nowrap\">20472<a name=\"example-referral-form-codes-20472\"> </a></td><td>Pelvis</td><td>Bassin</td></tr><tr><td style=\"white-space:nowrap\">20473<a name=\"example-referral-form-codes-20473\"> </a></td><td>Musculoskeletal</td><td>Musculosquelettique</td></tr><tr><td style=\"white-space:nowrap\">20474<a name=\"example-referral-form-codes-20474\"> </a></td><td>Angiography</td><td>Angiographie</td></tr><tr><td style=\"white-space:nowrap\">20476<a name=\"example-referral-form-codes-20476\"> </a></td><td>Breast</td><td>Sein</td></tr><tr><td style=\"white-space:nowrap\">20477<a name=\"example-referral-form-codes-20477\"> </a></td><td>Cardiac</td><td>Cardiaque</td></tr><tr><td style=\"white-space:nowrap\">20478<a name=\"example-referral-form-codes-20478\"> </a></td><td>Brain</td><td>Cerveau</td></tr><tr><td style=\"white-space:nowrap\">20480<a name=\"example-referral-form-codes-20480\"> </a></td><td>Internal auditory canals</td><td>Canaux auditifs internes</td></tr><tr><td style=\"white-space:nowrap\">20481<a name=\"example-referral-form-codes-20481\"> </a></td><td>Orbits</td><td>Orbites</td></tr><tr><td style=\"white-space:nowrap\">20482<a name=\"example-referral-form-codes-20482\"> </a></td><td>Pituitary / Sella</td><td>Hypophyse / Sella</td></tr><tr><td style=\"white-space:nowrap\">20483<a name=\"example-referral-form-codes-20483\"> </a></td><td>Sinuses</td><td>Sinus</td></tr><tr><td style=\"white-space:nowrap\">20484<a name=\"example-referral-form-codes-20484\"> </a></td><td>Temporomandibular joints</td><td>Articulations temporo-mandibulaires</td></tr><tr><td style=\"white-space:nowrap\">20485<a name=\"example-referral-form-codes-20485\"> </a></td><td>Trigeminal nerve</td><td>Nerf trijumeau</td></tr><tr><td style=\"white-space:nowrap\">20487<a name=\"example-referral-form-codes-20487\"> </a></td><td>Soft Tissue Neck</td><td>Tissu mou du cou</td></tr><tr><td style=\"white-space:nowrap\">20488<a name=\"example-referral-form-codes-20488\"> </a></td><td>Brachial plexus</td><td>Plexus brachial</td></tr><tr><td style=\"white-space:nowrap\">20489<a name=\"example-referral-form-codes-20489\"> </a></td><td>Whole Spine</td><td>Colonne vertébrale entière</td></tr><tr><td style=\"white-space:nowrap\">20490<a name=\"example-referral-form-codes-20490\"> </a></td><td>Cervical Spine</td><td>Colonne cervicale</td></tr><tr><td style=\"white-space:nowrap\">20491<a name=\"example-referral-form-codes-20491\"> </a></td><td>Thoracic Spine</td><td>Colonne thoracique</td></tr><tr><td style=\"white-space:nowrap\">20492<a name=\"example-referral-form-codes-20492\"> </a></td><td>Lumbar Spine</td><td>Colonne lombaire</td></tr><tr><td style=\"white-space:nowrap\">20493<a name=\"example-referral-form-codes-20493\"> </a></td><td>Sacrum/Coccyx</td><td>Sacrum/Coccyx</td></tr><tr><td style=\"white-space:nowrap\">20494<a name=\"example-referral-form-codes-20494\"> </a></td><td>Sacroiliac Joints</td><td>Articulations sacro-iliaques</td></tr><tr><td style=\"white-space:nowrap\">20495<a name=\"example-referral-form-codes-20495\"> </a></td><td>Chest</td><td>Thorax</td></tr><tr><td style=\"white-space:nowrap\">20496<a name=\"example-referral-form-codes-20496\"> </a></td><td>Chest wall</td><td>Paroi thoracique</td></tr><tr><td style=\"white-space:nowrap\">20497<a name=\"example-referral-form-codes-20497\"> </a></td><td>Pulmonary arteries</td><td>Artères pulmonaires</td></tr><tr><td style=\"white-space:nowrap\">20498<a name=\"example-referral-form-codes-20498\"> </a></td><td>Sternoclavicular joints</td><td>Articulations sternoclaviculaires</td></tr><tr><td style=\"white-space:nowrap\">20499<a name=\"example-referral-form-codes-20499\"> </a></td><td>Sternum</td><td>Sternum</td></tr><tr><td style=\"white-space:nowrap\">20501<a name=\"example-referral-form-codes-20501\"> </a></td><td>Thoracic Outlet</td><td>Défilé thoracique</td></tr><tr><td style=\"white-space:nowrap\">20503<a name=\"example-referral-form-codes-20503\"> </a></td><td>Abdominal wall</td><td>Paroi abdominale</td></tr><tr><td style=\"white-space:nowrap\">20504<a name=\"example-referral-form-codes-20504\"> </a></td><td>Adrenal glands</td><td>Glandes surrénales</td></tr><tr><td style=\"white-space:nowrap\">20505<a name=\"example-referral-form-codes-20505\"> </a></td><td>Biliary and pancreatic ducts</td><td>Voies biliaires et pancréatiques</td></tr><tr><td style=\"white-space:nowrap\">20506<a name=\"example-referral-form-codes-20506\"> </a></td><td>Enterography</td><td>Entérographie</td></tr><tr><td style=\"white-space:nowrap\">20507<a name=\"example-referral-form-codes-20507\"> </a></td><td>Kidneys</td><td>Reins</td></tr><tr><td style=\"white-space:nowrap\">20508<a name=\"example-referral-form-codes-20508\"> </a></td><td>Liver</td><td>Foie</td></tr><tr><td style=\"white-space:nowrap\">20509<a name=\"example-referral-form-codes-20509\"> </a></td><td>Pancreas</td><td>Pancréas</td></tr><tr><td style=\"white-space:nowrap\">20510<a name=\"example-referral-form-codes-20510\"> </a></td><td>Renal artery</td><td>Artère rénale</td></tr><tr><td style=\"white-space:nowrap\">20511<a name=\"example-referral-form-codes-20511\"> </a></td><td>Urography</td><td>Urographie</td></tr><tr><td style=\"white-space:nowrap\">20512<a name=\"example-referral-form-codes-20512\"> </a></td><td>Bladder</td><td>Vessie</td></tr><tr><td style=\"white-space:nowrap\">20513<a name=\"example-referral-form-codes-20513\"> </a></td><td>Gynecology (Uterus/ Ovaries/ Adnexal)</td><td>Gynécologie (Utérus/ Ovaires/ Annexes)</td></tr><tr><td style=\"white-space:nowrap\">20514<a name=\"example-referral-form-codes-20514\"> </a></td><td>Iliac arteries</td><td>Artères iliaques</td></tr><tr><td style=\"white-space:nowrap\">20515<a name=\"example-referral-form-codes-20515\"> </a></td><td>Piriformis</td><td>Piriforme</td></tr><tr><td style=\"white-space:nowrap\">20516<a name=\"example-referral-form-codes-20516\"> </a></td><td>Prostate</td><td>Prostate</td></tr><tr><td style=\"white-space:nowrap\">20517<a name=\"example-referral-form-codes-20517\"> </a></td><td>Rectum/ Anal</td><td>Rectum/ Anal</td></tr><tr><td style=\"white-space:nowrap\">20518<a name=\"example-referral-form-codes-20518\"> </a></td><td>Urogenital (Testicular/ Penile)</td><td>Urogénital (Testiculaire/ Pénien)</td></tr><tr><td style=\"white-space:nowrap\">20519<a name=\"example-referral-form-codes-20519\"> </a></td><td>Shoulder</td><td>Épaule</td></tr><tr><td style=\"white-space:nowrap\">20520<a name=\"example-referral-form-codes-20520\"> </a></td><td>Humerus</td><td>Humérus</td></tr><tr><td style=\"white-space:nowrap\">20521<a name=\"example-referral-form-codes-20521\"> </a></td><td>Elbow</td><td>Coude</td></tr><tr><td style=\"white-space:nowrap\">20522<a name=\"example-referral-form-codes-20522\"> </a></td><td>Forearm</td><td>Avant-bras</td></tr><tr><td style=\"white-space:nowrap\">20523<a name=\"example-referral-form-codes-20523\"> </a></td><td>Wrist</td><td>Poignet</td></tr><tr><td style=\"white-space:nowrap\">20524<a name=\"example-referral-form-codes-20524\"> </a></td><td>Hand</td><td>Main</td></tr><tr><td style=\"white-space:nowrap\">20525<a name=\"example-referral-form-codes-20525\"> </a></td><td>Finger</td><td/></tr><tr><td style=\"white-space:nowrap\">20526<a name=\"example-referral-form-codes-20526\"> </a></td><td>Bony Pelvis</td><td>Bassins osseux</td></tr><tr><td style=\"white-space:nowrap\">20527<a name=\"example-referral-form-codes-20527\"> </a></td><td>Hip</td><td>Hanche</td></tr><tr><td style=\"white-space:nowrap\">20528<a name=\"example-referral-form-codes-20528\"> </a></td><td>Femur / Thigh</td><td>Fémur / Cuisse</td></tr><tr><td style=\"white-space:nowrap\">20529<a name=\"example-referral-form-codes-20529\"> </a></td><td>Knee</td><td>Genou</td></tr><tr><td style=\"white-space:nowrap\">20530<a name=\"example-referral-form-codes-20530\"> </a></td><td>Tibia and Fibula</td><td>Tibia et Fibula</td></tr><tr><td style=\"white-space:nowrap\">20531<a name=\"example-referral-form-codes-20531\"> </a></td><td>Ankle</td><td>Cheville</td></tr><tr><td style=\"white-space:nowrap\">20532<a name=\"example-referral-form-codes-20532\"> </a></td><td>Foot</td><td>Pied</td></tr><tr><td style=\"white-space:nowrap\">20533<a name=\"example-referral-form-codes-20533\"> </a></td><td>Toe</td><td>Orteil</td></tr><tr><td style=\"white-space:nowrap\">20534<a name=\"example-referral-form-codes-20534\"> </a></td><td>Arthrogram</td><td>Arthrogramme</td></tr><tr><td style=\"white-space:nowrap\">20535<a name=\"example-referral-form-codes-20535\"> </a></td><td>Arthrogram</td><td>Arthrogramme</td></tr><tr><td style=\"white-space:nowrap\">20536<a name=\"example-referral-form-codes-20536\"> </a></td><td>Arthrogram</td><td>Arthrogramme</td></tr><tr><td style=\"white-space:nowrap\">20537<a name=\"example-referral-form-codes-20537\"> </a></td><td>Arthrogram</td><td>Arthrogramme</td></tr><tr><td style=\"white-space:nowrap\">20538<a name=\"example-referral-form-codes-20538\"> </a></td><td>Arthrogram</td><td>Arthrogramme</td></tr><tr><td style=\"white-space:nowrap\">20539<a name=\"example-referral-form-codes-20539\"> </a></td><td>Arthrogram</td><td>Arthrogramme</td></tr><tr><td style=\"white-space:nowrap\">20540<a name=\"example-referral-form-codes-20540\"> </a></td><td>Head Angiography</td><td>Angiographie de la tête</td></tr><tr><td style=\"white-space:nowrap\">20541<a name=\"example-referral-form-codes-20541\"> </a></td><td>Neck Angiography</td><td>Angiographie du cou</td></tr><tr><td style=\"white-space:nowrap\">20542<a name=\"example-referral-form-codes-20542\"> </a></td><td>Chest Angiography</td><td>Angiographie thoracique</td></tr><tr><td style=\"white-space:nowrap\">20543<a name=\"example-referral-form-codes-20543\"> </a></td><td>Abdomen Angiography</td><td>Angiographie abdominale</td></tr><tr><td style=\"white-space:nowrap\">20544<a name=\"example-referral-form-codes-20544\"> </a></td><td>Pelvis Angiography</td><td>Angiographie pelvienne</td></tr><tr><td style=\"white-space:nowrap\">20545<a name=\"example-referral-form-codes-20545\"> </a></td><td>Upper Extremity Angiography</td><td>Angiographie des membres supérieurs</td></tr><tr><td style=\"white-space:nowrap\">20546<a name=\"example-referral-form-codes-20546\"> </a></td><td>Lower Extremity Angiography</td><td>Angiographie des membres inférieurs</td></tr><tr><td style=\"white-space:nowrap\">20554<a name=\"example-referral-form-codes-20554\"> </a></td><td>Diagnostic</td><td>Diagnostique</td></tr><tr><td style=\"white-space:nowrap\">20555<a name=\"example-referral-form-codes-20555\"> </a></td><td>Implant</td><td>Implant</td></tr><tr><td style=\"white-space:nowrap\">20556<a name=\"example-referral-form-codes-20556\"> </a></td><td>Chest (default Chest 2 views)</td><td>Thorax (par défaut Thorax 2 vues)</td></tr><tr><td style=\"white-space:nowrap\">20557<a name=\"example-referral-form-codes-20557\"> </a></td><td>Abdomen</td><td>Abdomen</td></tr><tr><td style=\"white-space:nowrap\">20558<a name=\"example-referral-form-codes-20558\"> </a></td><td>Spine</td><td>Colonne vertébrale</td></tr><tr><td style=\"white-space:nowrap\">20559<a name=\"example-referral-form-codes-20559\"> </a></td><td>Head and Neck</td><td>Tête et cou</td></tr><tr><td style=\"white-space:nowrap\">20560<a name=\"example-referral-form-codes-20560\"> </a></td><td>Upper Extremities</td><td>Membres supérieurs</td></tr><tr><td style=\"white-space:nowrap\">20561<a name=\"example-referral-form-codes-20561\"> </a></td><td>Lower Extremities</td><td>Membres inférieurs</td></tr><tr><td style=\"white-space:nowrap\">20562<a name=\"example-referral-form-codes-20562\"> </a></td><td>Mammogram (Non-OBSP)</td><td>Mammographie (Non-OBSP)</td></tr><tr><td style=\"white-space:nowrap\">20563<a name=\"example-referral-form-codes-20563\"> </a></td><td>Bone Age</td><td>Âge osseux</td></tr><tr><td style=\"white-space:nowrap\">20564<a name=\"example-referral-form-codes-20564\"> </a></td><td>Survey</td><td>Examen général</td></tr><tr><td style=\"white-space:nowrap\">20565<a name=\"example-referral-form-codes-20565\"> </a></td><td>Gastric and Fluoroscopic imaging</td><td>Imagerie gastrique et fluoroscopique</td></tr><tr><td style=\"white-space:nowrap\">20566<a name=\"example-referral-form-codes-20566\"> </a></td><td>One view (PA)</td><td>Une vue (PA)</td></tr><tr><td style=\"white-space:nowrap\">20567<a name=\"example-referral-form-codes-20567\"> </a></td><td>Two Views (PA, Lat)</td><td>Deux vues (PA, Lat)</td></tr><tr><td style=\"white-space:nowrap\">20568<a name=\"example-referral-form-codes-20568\"> </a></td><td>Three views (PA inspiration, PA expiration, Lat)</td><td>Trois vues (PA inspiration, PA expiration, Lat)</td></tr><tr><td style=\"white-space:nowrap\">20569<a name=\"example-referral-form-codes-20569\"> </a></td><td>Sternum</td><td>Sternum</td></tr><tr><td style=\"white-space:nowrap\">20570<a name=\"example-referral-form-codes-20570\"> </a></td><td>Ribs</td><td>Côtes</td></tr><tr><td style=\"white-space:nowrap\">20571<a name=\"example-referral-form-codes-20571\"> </a></td><td>Thoracic inlet</td><td>Orifice thoracique</td></tr><tr><td style=\"white-space:nowrap\">20572<a name=\"example-referral-form-codes-20572\"> </a></td><td>Sternoclavicular Joints</td><td>Articulations sternoclaviculaires</td></tr><tr><td style=\"white-space:nowrap\">20573<a name=\"example-referral-form-codes-20573\"> </a></td><td>One view (Supine)</td><td>Une vue (Décubitus)</td></tr><tr><td style=\"white-space:nowrap\">20574<a name=\"example-referral-form-codes-20574\"> </a></td><td>One view (Upright)</td><td>Une vue (Debout)</td></tr><tr><td style=\"white-space:nowrap\">20575<a name=\"example-referral-form-codes-20575\"> </a></td><td>KUB (Kidney Ureters Bladder)</td><td>KUB (Rein Uretères Vessie)</td></tr><tr><td style=\"white-space:nowrap\">20576<a name=\"example-referral-form-codes-20576\"> </a></td><td>Cervical</td><td>Cervical</td></tr><tr><td style=\"white-space:nowrap\">20577<a name=\"example-referral-form-codes-20577\"> </a></td><td>Cervical spine flexion extension</td><td>Flexion extension de la colonne cervicale</td></tr><tr><td style=\"white-space:nowrap\">20578<a name=\"example-referral-form-codes-20578\"> </a></td><td>Thoracic</td><td>Thoracique</td></tr><tr><td style=\"white-space:nowrap\">20579<a name=\"example-referral-form-codes-20579\"> </a></td><td>Lumbar</td><td>Lombaire</td></tr><tr><td style=\"white-space:nowrap\">20580<a name=\"example-referral-form-codes-20580\"> </a></td><td>Lumbar spine flexion extension</td><td>Flexion extension de la colonne lombaire</td></tr><tr><td style=\"white-space:nowrap\">20581<a name=\"example-referral-form-codes-20581\"> </a></td><td>Sacrum</td><td>Sacrum</td></tr><tr><td style=\"white-space:nowrap\">20582<a name=\"example-referral-form-codes-20582\"> </a></td><td>Coccyx</td><td>Coccyx</td></tr><tr><td style=\"white-space:nowrap\">20583<a name=\"example-referral-form-codes-20583\"> </a></td><td>Sacroiliac joints</td><td>Articulations sacro-iliaques</td></tr><tr><td style=\"white-space:nowrap\">20584<a name=\"example-referral-form-codes-20584\"> </a></td><td>Scoliosis spine</td><td>Colonne vertébrale scoliose</td></tr><tr><td style=\"white-space:nowrap\">20585<a name=\"example-referral-form-codes-20585\"> </a></td><td>Skull</td><td>Crâne</td></tr><tr><td style=\"white-space:nowrap\">20586<a name=\"example-referral-form-codes-20586\"> </a></td><td>Orbits</td><td>Orbites</td></tr><tr><td style=\"white-space:nowrap\">20587<a name=\"example-referral-form-codes-20587\"> </a></td><td>Neck for soft tissue</td><td>Cou pour les tissus mous</td></tr><tr><td style=\"white-space:nowrap\">20588<a name=\"example-referral-form-codes-20588\"> </a></td><td>Mastoids</td><td>Mastoïdes</td></tr><tr><td style=\"white-space:nowrap\">20589<a name=\"example-referral-form-codes-20589\"> </a></td><td>Nasal bones</td><td>Os nasaux</td></tr><tr><td style=\"white-space:nowrap\">20590<a name=\"example-referral-form-codes-20590\"> </a></td><td>Facal bones</td><td>Os faciaux</td></tr><tr><td style=\"white-space:nowrap\">20591<a name=\"example-referral-form-codes-20591\"> </a></td><td>Mandible</td><td>Mandibule</td></tr><tr><td style=\"white-space:nowrap\">20592<a name=\"example-referral-form-codes-20592\"> </a></td><td>Temporomandibular joints</td><td>Articulations temporo-mandibulaires</td></tr><tr><td style=\"white-space:nowrap\">20593<a name=\"example-referral-form-codes-20593\"> </a></td><td>Sinus</td><td>Sinus</td></tr><tr><td style=\"white-space:nowrap\">20594<a name=\"example-referral-form-codes-20594\"> </a></td><td>Trauma or injury</td><td>Traumatisme ou blessure</td></tr><tr><td style=\"white-space:nowrap\">20595<a name=\"example-referral-form-codes-20595\"> </a></td><td>Eye for foreign body</td><td>Œil pour corps étranger</td></tr><tr><td style=\"white-space:nowrap\">20596<a name=\"example-referral-form-codes-20596\"> </a></td><td>Shoulder</td><td>Épaule</td></tr><tr><td style=\"white-space:nowrap\">20597<a name=\"example-referral-form-codes-20597\"> </a></td><td>Clavicle</td><td>Clavicule</td></tr><tr><td style=\"white-space:nowrap\">20598<a name=\"example-referral-form-codes-20598\"> </a></td><td>Acromioclavicular joints</td><td>Articulations acromioclaviculaires</td></tr><tr><td style=\"white-space:nowrap\">20599<a name=\"example-referral-form-codes-20599\"> </a></td><td>Scapula</td><td>Omoplate</td></tr><tr><td style=\"white-space:nowrap\">20600<a name=\"example-referral-form-codes-20600\"> </a></td><td>Humerus</td><td>Humérus</td></tr><tr><td style=\"white-space:nowrap\">20601<a name=\"example-referral-form-codes-20601\"> </a></td><td>Elbow</td><td>Coude</td></tr><tr><td style=\"white-space:nowrap\">20602<a name=\"example-referral-form-codes-20602\"> </a></td><td>Forearm</td><td>Avant-bras</td></tr><tr><td style=\"white-space:nowrap\">20603<a name=\"example-referral-form-codes-20603\"> </a></td><td>Wrist</td><td>Poignet</td></tr><tr><td style=\"white-space:nowrap\">20604<a name=\"example-referral-form-codes-20604\"> </a></td><td>Scaphoid</td><td>Scaphoïde</td></tr><tr><td style=\"white-space:nowrap\">20605<a name=\"example-referral-form-codes-20605\"> </a></td><td>Hand</td><td>Main</td></tr><tr><td style=\"white-space:nowrap\">20606<a name=\"example-referral-form-codes-20606\"> </a></td><td>Finger</td><td>Doigt</td></tr><tr><td style=\"white-space:nowrap\">20607<a name=\"example-referral-form-codes-20607\"> </a></td><td>Pelvis</td><td>Bassins</td></tr><tr><td style=\"white-space:nowrap\">20608<a name=\"example-referral-form-codes-20608\"> </a></td><td>Hip</td><td>Hanche</td></tr><tr><td style=\"white-space:nowrap\">20609<a name=\"example-referral-form-codes-20609\"> </a></td><td>Femur</td><td>Fémur</td></tr><tr><td style=\"white-space:nowrap\">20610<a name=\"example-referral-form-codes-20610\"> </a></td><td>Knee</td><td>Genou</td></tr><tr><td style=\"white-space:nowrap\">20611<a name=\"example-referral-form-codes-20611\"> </a></td><td>Patella</td><td>Rotule</td></tr><tr><td style=\"white-space:nowrap\">20612<a name=\"example-referral-form-codes-20612\"> </a></td><td>Tibia and fibula</td><td>Tibia et fibula</td></tr><tr><td style=\"white-space:nowrap\">20613<a name=\"example-referral-form-codes-20613\"> </a></td><td>Ankle</td><td>Cheville</td></tr><tr><td style=\"white-space:nowrap\">20614<a name=\"example-referral-form-codes-20614\"> </a></td><td>Foot</td><td>Pied</td></tr><tr><td style=\"white-space:nowrap\">20615<a name=\"example-referral-form-codes-20615\"> </a></td><td>Calcaneus</td><td>Calcanéum</td></tr><tr><td style=\"white-space:nowrap\">20616<a name=\"example-referral-form-codes-20616\"> </a></td><td>Toes</td><td>Orteils</td></tr><tr><td style=\"white-space:nowrap\">20617<a name=\"example-referral-form-codes-20617\"> </a></td><td>Leg length</td><td>Longueur de jambe</td></tr><tr><td style=\"white-space:nowrap\">20618<a name=\"example-referral-form-codes-20618\"> </a></td><td>Metabolic</td><td>Métabolique</td></tr><tr><td style=\"white-space:nowrap\">20619<a name=\"example-referral-form-codes-20619\"> </a></td><td>Metastatic</td><td>Métastatique</td></tr><tr><td style=\"white-space:nowrap\">20620<a name=\"example-referral-form-codes-20620\"> </a></td><td>Rheumatoid</td><td>Rhumatoïde</td></tr><tr><td style=\"white-space:nowrap\">20621<a name=\"example-referral-form-codes-20621\"> </a></td><td>Babygram</td><td>Radiographie du bébé</td></tr><tr><td style=\"white-space:nowrap\">20622<a name=\"example-referral-form-codes-20622\"> </a></td><td>Gastrointestinal tract</td><td>Tube gastro-intestinal</td></tr><tr><td style=\"white-space:nowrap\">20623<a name=\"example-referral-form-codes-20623\"> </a></td><td>Retrograde urethrogram</td><td>Uréthrogramme rétrograde</td></tr><tr><td style=\"white-space:nowrap\">20624<a name=\"example-referral-form-codes-20624\"> </a></td><td>Cystourethrogram</td><td>Cystouréthrogramme</td></tr><tr><td style=\"white-space:nowrap\">20625<a name=\"example-referral-form-codes-20625\"> </a></td><td>Hysterosalpingogram</td><td>Hystérosalpingogramme</td></tr><tr><td style=\"white-space:nowrap\">20626<a name=\"example-referral-form-codes-20626\"> </a></td><td>Sinogram</td><td>Sinogramme</td></tr><tr><td style=\"white-space:nowrap\">20627<a name=\"example-referral-form-codes-20627\"> </a></td><td>Musculoskeletal injections</td><td>Injections musculosquelettiques</td></tr><tr><td style=\"white-space:nowrap\">20628<a name=\"example-referral-form-codes-20628\"> </a></td><td>Modified barium swallow (Video fluoroscope swallowing exam)</td><td>Déglutition au baryum modifiée (Examen de déglutition par fluoroscope vidéo)</td></tr><tr><td style=\"white-space:nowrap\">20629<a name=\"example-referral-form-codes-20629\"> </a></td><td>Barium swallow</td><td>Déglutition au baryum</td></tr><tr><td style=\"white-space:nowrap\">20630<a name=\"example-referral-form-codes-20630\"> </a></td><td>Upper GI series (Esophagus, stomach and duodenum)</td><td>Série GI supérieure (Œsophage, estomac et duodénum)</td></tr><tr><td style=\"white-space:nowrap\">20631<a name=\"example-referral-form-codes-20631\"> </a></td><td>Small bowel follow through</td><td>Suivi de l'intestin grêle</td></tr><tr><td style=\"white-space:nowrap\">20632<a name=\"example-referral-form-codes-20632\"> </a></td><td>Barium enema</td><td>Lavement baryté</td></tr><tr><td style=\"white-space:nowrap\">20633<a name=\"example-referral-form-codes-20633\"> </a></td><td>Stress</td><td>Stress</td></tr><tr><td style=\"white-space:nowrap\">20634<a name=\"example-referral-form-codes-20634\"> </a></td><td>Voiding</td><td>Miction</td></tr><tr><td style=\"white-space:nowrap\">20635<a name=\"example-referral-form-codes-20635\"> </a></td><td>Abdomen</td><td>Abdomen</td></tr><tr><td style=\"white-space:nowrap\">20636<a name=\"example-referral-form-codes-20636\"> </a></td><td>Pelvis</td><td>Bassins</td></tr><tr><td style=\"white-space:nowrap\">20637<a name=\"example-referral-form-codes-20637\"> </a></td><td>Obstetrical</td><td>Obstétrical</td></tr><tr><td style=\"white-space:nowrap\">20638<a name=\"example-referral-form-codes-20638\"> </a></td><td>Neonatal and Paediatric</td><td>Néonatal et pédiatrique</td></tr><tr><td style=\"white-space:nowrap\">20639<a name=\"example-referral-form-codes-20639\"> </a></td><td>Musculoskeletal</td><td>Musculosquelettique</td></tr><tr><td style=\"white-space:nowrap\">20640<a name=\"example-referral-form-codes-20640\"> </a></td><td>Vascular</td><td>Vasculaire</td></tr><tr><td style=\"white-space:nowrap\">20641<a name=\"example-referral-form-codes-20641\"> </a></td><td>Head and Neck</td><td>Tête et cou</td></tr><tr><td style=\"white-space:nowrap\">20642<a name=\"example-referral-form-codes-20642\"> </a></td><td>Breast and Axilla</td><td>Sein et aisselle</td></tr><tr><td style=\"white-space:nowrap\">20643<a name=\"example-referral-form-codes-20643\"> </a></td><td>Complete abdomen</td><td>Abdomen complet</td></tr><tr><td style=\"white-space:nowrap\">20644<a name=\"example-referral-form-codes-20644\"> </a></td><td>Appendix</td><td>Appendice</td></tr><tr><td style=\"white-space:nowrap\">20645<a name=\"example-referral-form-codes-20645\"> </a></td><td>Gallbladder</td><td>Vésicule biliaire</td></tr><tr><td style=\"white-space:nowrap\">20646<a name=\"example-referral-form-codes-20646\"> </a></td><td>Kidney Ureters Bladder</td><td>Rein Uretères Vessie</td></tr><tr><td style=\"white-space:nowrap\">20647<a name=\"example-referral-form-codes-20647\"> </a></td><td>Liver</td><td>Foie</td></tr><tr><td style=\"white-space:nowrap\">20648<a name=\"example-referral-form-codes-20648\"> </a></td><td>Liver elastography</td><td>Élastographie du foie</td></tr><tr><td style=\"white-space:nowrap\">20649<a name=\"example-referral-form-codes-20649\"> </a></td><td>Pancreas</td><td>Pancréas</td></tr><tr><td style=\"white-space:nowrap\">20650<a name=\"example-referral-form-codes-20650\"> </a></td><td>Portal hypertension</td><td>Hypertension portale</td></tr><tr><td style=\"white-space:nowrap\">20651<a name=\"example-referral-form-codes-20651\"> </a></td><td>Renal</td><td>Rénal</td></tr><tr><td style=\"white-space:nowrap\">20652<a name=\"example-referral-form-codes-20652\"> </a></td><td>Right upper quadrant</td><td>Quadrant supérieur droit</td></tr><tr><td style=\"white-space:nowrap\">20653<a name=\"example-referral-form-codes-20653\"> </a></td><td>Spleen</td><td>Rate</td></tr><tr><td style=\"white-space:nowrap\">20654<a name=\"example-referral-form-codes-20654\"> </a></td><td>Abdomen contrast</td><td>Abdomen avec contraste</td></tr><tr><td style=\"white-space:nowrap\">20655<a name=\"example-referral-form-codes-20655\"> </a></td><td>Abdominal wall</td><td>Paroi abdominale</td></tr><tr><td style=\"white-space:nowrap\">20656<a name=\"example-referral-form-codes-20656\"> </a></td><td>Complete pelvis</td><td>Bassins complet</td></tr><tr><td style=\"white-space:nowrap\">20657<a name=\"example-referral-form-codes-20657\"> </a></td><td>Pelvis transabdominal</td><td>Bassins transabdominal</td></tr><tr><td style=\"white-space:nowrap\">20658<a name=\"example-referral-form-codes-20658\"> </a></td><td>Female pelvis (transvaginal)</td><td>Bassins féminin (transvaginal)</td></tr><tr><td style=\"white-space:nowrap\">20659<a name=\"example-referral-form-codes-20659\"> </a></td><td>Follicular monitoring</td><td>Surveillance folliculaire</td></tr><tr><td style=\"white-space:nowrap\">20660<a name=\"example-referral-form-codes-20660\"> </a></td><td>Limited non-pregnancy (for IUD insertion placement check)</td><td>Non-grossesse limitée (pour vérification de l'insertion du DIU)</td></tr><tr><td style=\"white-space:nowrap\">20661<a name=\"example-referral-form-codes-20661\"> </a></td><td>Saline Infusion Sonohysterography</td><td>Sonohystérographie par perfusion de sérum physiologique</td></tr><tr><td style=\"white-space:nowrap\">20662<a name=\"example-referral-form-codes-20662\"> </a></td><td>Male pelvis (Transrectal)</td><td>Bassins masculin (transrectal)</td></tr><tr><td style=\"white-space:nowrap\">20663<a name=\"example-referral-form-codes-20663\"> </a></td><td>Prostate</td><td>Prostate</td></tr><tr><td style=\"white-space:nowrap\">20664<a name=\"example-referral-form-codes-20664\"> </a></td><td>Penile</td><td>Pénien</td></tr><tr><td style=\"white-space:nowrap\">20665<a name=\"example-referral-form-codes-20665\"> </a></td><td>Testicles/Scrotum</td><td>Testicules/Scrotum</td></tr><tr><td style=\"white-space:nowrap\">20666<a name=\"example-referral-form-codes-20666\"> </a></td><td>Bladder</td><td>Vessie</td></tr><tr><td style=\"white-space:nowrap\">20667<a name=\"example-referral-form-codes-20667\"> </a></td><td>Groin</td><td>Aine</td></tr><tr><td style=\"white-space:nowrap\">20668<a name=\"example-referral-form-codes-20668\"> </a></td><td>Singleton</td><td>Grossesse unique</td></tr><tr><td style=\"white-space:nowrap\">20669<a name=\"example-referral-form-codes-20669\"> </a></td><td>Twins</td><td>Jumeaux</td></tr><tr><td style=\"white-space:nowrap\">20670<a name=\"example-referral-form-codes-20670\"> </a></td><td>Triplets</td><td>Triplés</td></tr><tr><td style=\"white-space:nowrap\">20671<a name=\"example-referral-form-codes-20671\"> </a></td><td>Unknown</td><td>Inconnu</td></tr><tr><td style=\"white-space:nowrap\">20672<a name=\"example-referral-form-codes-20672\"> </a></td><td>Dating (&lt;16 weeks)</td><td>Datation (&lt;16 semaines)</td></tr><tr><td style=\"white-space:nowrap\">20673<a name=\"example-referral-form-codes-20673\"> </a></td><td>Prenatal screening (NT/eFTS) 11-14 weeks</td><td>Dépistage prénatal (NT/eFTS) 11-14 semaines</td></tr><tr><td style=\"white-space:nowrap\">20674<a name=\"example-referral-form-codes-20674\"> </a></td><td>Anatomy (20 week scan)</td><td>Anatomie (échographie de 20 semaines)</td></tr><tr><td style=\"white-space:nowrap\">20675<a name=\"example-referral-form-codes-20675\"> </a></td><td>2nd or 3rd trimester scan</td><td>Échographie du 2e ou 3e trimestre</td></tr><tr><td style=\"white-space:nowrap\">20676<a name=\"example-referral-form-codes-20676\"> </a></td><td>Biophysical profile</td><td>Profil bio-physique</td></tr><tr><td style=\"white-space:nowrap\">20677<a name=\"example-referral-form-codes-20677\"> </a></td><td>Growth</td><td>Croissance</td></tr><tr><td style=\"white-space:nowrap\">20678<a name=\"example-referral-form-codes-20678\"> </a></td><td>Cervical length</td><td>Longueur cervicale</td></tr><tr><td style=\"white-space:nowrap\">20745<a name=\"example-referral-form-codes-20745\"> </a></td><td>With transvaginal</td><td>Avec transvaginal</td></tr><tr><td style=\"white-space:nowrap\">20679<a name=\"example-referral-form-codes-20679\"> </a></td><td>Multi-gestational study</td><td>Étude multi-gestationnelle</td></tr><tr><td style=\"white-space:nowrap\">20680<a name=\"example-referral-form-codes-20680\"> </a></td><td>High risk pregnancy</td><td>Grossesse à haut risque</td></tr><tr><td style=\"white-space:nowrap\">20681<a name=\"example-referral-form-codes-20681\"> </a></td><td>Uterine artery doppler studies</td><td>Études Doppler de l'artère utérine</td></tr><tr><td style=\"white-space:nowrap\">20682<a name=\"example-referral-form-codes-20682\"> </a></td><td>Umbilical artery doppler studies</td><td>Études Doppler de l'artère ombilicale</td></tr><tr><td style=\"white-space:nowrap\">20683<a name=\"example-referral-form-codes-20683\"> </a></td><td>Fetal doppler</td><td>Doppler fœtal</td></tr><tr><td style=\"white-space:nowrap\">20684<a name=\"example-referral-form-codes-20684\"> </a></td><td>Report sex</td><td>Indiquer le sexe</td></tr><tr><td style=\"white-space:nowrap\">20685<a name=\"example-referral-form-codes-20685\"> </a></td><td>1st Trimester</td><td/></tr><tr><td style=\"white-space:nowrap\">20686<a name=\"example-referral-form-codes-20686\"> </a></td><td>2nd and 3rd Trimester</td><td/></tr><tr><td style=\"white-space:nowrap\">20687<a name=\"example-referral-form-codes-20687\"> </a></td><td>Pylorus</td><td/></tr><tr><td style=\"white-space:nowrap\">20688<a name=\"example-referral-form-codes-20688\"> </a></td><td>Spine</td><td/></tr><tr><td style=\"white-space:nowrap\">20689<a name=\"example-referral-form-codes-20689\"> </a></td><td>Brain</td><td/></tr><tr><td style=\"white-space:nowrap\">20690<a name=\"example-referral-form-codes-20690\"> </a></td><td>Hips</td><td/></tr><tr><td style=\"white-space:nowrap\">20691<a name=\"example-referral-form-codes-20691\"> </a></td><td>Pylorus and Hypertrophic Pyloric Stenosis</td><td/></tr><tr><td style=\"white-space:nowrap\">20692<a name=\"example-referral-form-codes-20692\"> </a></td><td>Bowel</td><td/></tr><tr><td style=\"white-space:nowrap\">20693<a name=\"example-referral-form-codes-20693\"> </a></td><td>Foot</td><td/></tr><tr><td style=\"white-space:nowrap\">20694<a name=\"example-referral-form-codes-20694\"> </a></td><td>Plantar fascia</td><td/></tr><tr><td style=\"white-space:nowrap\">20695<a name=\"example-referral-form-codes-20695\"> </a></td><td>Ankle</td><td/></tr><tr><td style=\"white-space:nowrap\">20696<a name=\"example-referral-form-codes-20696\"> </a></td><td>Achilles</td><td/></tr><tr><td style=\"white-space:nowrap\">20697<a name=\"example-referral-form-codes-20697\"> </a></td><td>Calf/Lower leg/Gastrocnemius</td><td/></tr><tr><td style=\"white-space:nowrap\">20698<a name=\"example-referral-form-codes-20698\"> </a></td><td>Knee</td><td/></tr><tr><td style=\"white-space:nowrap\">20699<a name=\"example-referral-form-codes-20699\"> </a></td><td>Patellar tendon</td><td/></tr><tr><td style=\"white-space:nowrap\">20700<a name=\"example-referral-form-codes-20700\"> </a></td><td>Popliteal fossa</td><td/></tr><tr><td style=\"white-space:nowrap\">20701<a name=\"example-referral-form-codes-20701\"> </a></td><td>Quadriceps tendon</td><td/></tr><tr><td style=\"white-space:nowrap\">20702<a name=\"example-referral-form-codes-20702\"> </a></td><td>Thigh/Hamstrings</td><td/></tr><tr><td style=\"white-space:nowrap\">20703<a name=\"example-referral-form-codes-20703\"> </a></td><td>Hip</td><td/></tr><tr><td style=\"white-space:nowrap\">20704<a name=\"example-referral-form-codes-20704\"> </a></td><td>Gluteal region</td><td/></tr><tr><td style=\"white-space:nowrap\">20705<a name=\"example-referral-form-codes-20705\"> </a></td><td>Hand</td><td/></tr><tr><td style=\"white-space:nowrap\">20706<a name=\"example-referral-form-codes-20706\"> </a></td><td>Wrist</td><td/></tr><tr><td style=\"white-space:nowrap\">20707<a name=\"example-referral-form-codes-20707\"> </a></td><td>Carpal tunnel</td><td/></tr><tr><td style=\"white-space:nowrap\">20708<a name=\"example-referral-form-codes-20708\"> </a></td><td>Forearm</td><td/></tr><tr><td style=\"white-space:nowrap\">20709<a name=\"example-referral-form-codes-20709\"> </a></td><td>Elbow</td><td/></tr><tr><td style=\"white-space:nowrap\">20710<a name=\"example-referral-form-codes-20710\"> </a></td><td>Biceps</td><td/></tr><tr><td style=\"white-space:nowrap\">20711<a name=\"example-referral-form-codes-20711\"> </a></td><td>Triceps</td><td/></tr><tr><td style=\"white-space:nowrap\">20712<a name=\"example-referral-form-codes-20712\"> </a></td><td>Shoulders</td><td/></tr><tr><td style=\"white-space:nowrap\">20713<a name=\"example-referral-form-codes-20713\"> </a></td><td>Rotator cuff</td><td/></tr><tr><td style=\"white-space:nowrap\">20714<a name=\"example-referral-form-codes-20714\"> </a></td><td>Toe(s)</td><td/></tr><tr><td style=\"white-space:nowrap\">20715<a name=\"example-referral-form-codes-20715\"> </a></td><td>Finger(s)</td><td/></tr><tr><td style=\"white-space:nowrap\">20716<a name=\"example-referral-form-codes-20716\"> </a></td><td>Palpable masses</td><td/></tr><tr><td style=\"white-space:nowrap\">20717<a name=\"example-referral-form-codes-20717\"> </a></td><td>Foreign body</td><td/></tr><tr><td style=\"white-space:nowrap\">20718<a name=\"example-referral-form-codes-20718\"> </a></td><td>Upper extremity arterial</td><td/></tr><tr><td style=\"white-space:nowrap\">20719<a name=\"example-referral-form-codes-20719\"> </a></td><td>Upper extremity venous</td><td/></tr><tr><td style=\"white-space:nowrap\">20720<a name=\"example-referral-form-codes-20720\"> </a></td><td>Lower extremity arterial</td><td/></tr><tr><td style=\"white-space:nowrap\">20721<a name=\"example-referral-form-codes-20721\"> </a></td><td>Lower extremity venous thrombosis</td><td/></tr><tr><td style=\"white-space:nowrap\">20722<a name=\"example-referral-form-codes-20722\"> </a></td><td>Lower extremity venous reflux</td><td/></tr><tr><td style=\"white-space:nowrap\">20723<a name=\"example-referral-form-codes-20723\"> </a></td><td>Abdominal aortic aneurysm screen</td><td/></tr><tr><td style=\"white-space:nowrap\">20724<a name=\"example-referral-form-codes-20724\"> </a></td><td>Ankle brachial index</td><td/></tr><tr><td style=\"white-space:nowrap\">20725<a name=\"example-referral-form-codes-20725\"> </a></td><td>Arterial venous fistula</td><td/></tr><tr><td style=\"white-space:nowrap\">20726<a name=\"example-referral-form-codes-20726\"> </a></td><td>Carotid</td><td/></tr><tr><td style=\"white-space:nowrap\">20727<a name=\"example-referral-form-codes-20727\"> </a></td><td>Inferior vena cava</td><td/></tr><tr><td style=\"white-space:nowrap\">20728<a name=\"example-referral-form-codes-20728\"> </a></td><td>Portal vein</td><td/></tr><tr><td style=\"white-space:nowrap\">20729<a name=\"example-referral-form-codes-20729\"> </a></td><td>Renal arteries</td><td/></tr><tr><td style=\"white-space:nowrap\">20730<a name=\"example-referral-form-codes-20730\"> </a></td><td>Superior mesenteric artery (SMA)</td><td/></tr><tr><td style=\"white-space:nowrap\">20731<a name=\"example-referral-form-codes-20731\"> </a></td><td>Temporal arteries</td><td/></tr><tr><td style=\"white-space:nowrap\">20732<a name=\"example-referral-form-codes-20732\"> </a></td><td>Venous mapping</td><td/></tr><tr><td style=\"white-space:nowrap\">20733<a name=\"example-referral-form-codes-20733\"> </a></td><td>Neck/Salivary gland</td><td/></tr><tr><td style=\"white-space:nowrap\">20734<a name=\"example-referral-form-codes-20734\"> </a></td><td>Lymph nodes</td><td/></tr><tr><td style=\"white-space:nowrap\">20735<a name=\"example-referral-form-codes-20735\"> </a></td><td>Thyroid</td><td/></tr><tr><td style=\"white-space:nowrap\">20736<a name=\"example-referral-form-codes-20736\"> </a></td><td>Breast</td><td/></tr><tr><td style=\"white-space:nowrap\">20737<a name=\"example-referral-form-codes-20737\"> </a></td><td>Axilla</td><td/></tr><tr><td style=\"white-space:nowrap\">20738<a name=\"example-referral-form-codes-20738\"> </a></td><td>Chest</td><td/></tr><tr><td style=\"white-space:nowrap\">20739<a name=\"example-referral-form-codes-20739\"> </a></td><td>Chest wall (mass)</td><td/></tr><tr><td style=\"white-space:nowrap\">20740<a name=\"example-referral-form-codes-20740\"> </a></td><td>Soft tissue</td><td/></tr><tr><td style=\"white-space:nowrap\">20741<a name=\"example-referral-form-codes-20741\"> </a></td><td>Baseline</td><td/></tr><tr><td style=\"white-space:nowrap\">20742<a name=\"example-referral-form-codes-20742\"> </a></td><td>Low Risk</td><td/></tr><tr><td style=\"white-space:nowrap\">20743<a name=\"example-referral-form-codes-20743\"> </a></td><td>High Risk</td><td/></tr><tr><td style=\"white-space:nowrap\">20748<a name=\"example-referral-form-codes-20748\"> </a></td><td>Breast</td><td/></tr><tr><td style=\"white-space:nowrap\">20749<a name=\"example-referral-form-codes-20749\"> </a></td><td>Burns and Sequelae</td><td/></tr><tr><td style=\"white-space:nowrap\">20750<a name=\"example-referral-form-codes-20750\"> </a></td><td>Congenital Conditions</td><td/></tr><tr><td style=\"white-space:nowrap\">20751<a name=\"example-referral-form-codes-20751\"> </a></td><td>Facial Trauma and Reconstruction</td><td/></tr><tr><td style=\"white-space:nowrap\">20752<a name=\"example-referral-form-codes-20752\"> </a></td><td>Gender-Affirming Surgery</td><td/></tr><tr><td style=\"white-space:nowrap\">20753<a name=\"example-referral-form-codes-20753\"> </a></td><td>Hand and Upper Limb</td><td/></tr><tr><td style=\"white-space:nowrap\">20754<a name=\"example-referral-form-codes-20754\"> </a></td><td>Peripheral Nerve, Carpal Tunnel Syndrome, and Brachial Plexus</td><td/></tr><tr><td style=\"white-space:nowrap\">20755<a name=\"example-referral-form-codes-20755\"> </a></td><td>Skin Lesions and Skin Cancer</td><td/></tr><tr><td style=\"white-space:nowrap\">20756<a name=\"example-referral-form-codes-20756\"> </a></td><td>Soft Tissue Tumours</td><td/></tr><tr><td style=\"white-space:nowrap\">20757<a name=\"example-referral-form-codes-20757\"> </a></td><td>Wound - Acute</td><td/></tr><tr><td style=\"white-space:nowrap\">20758<a name=\"example-referral-form-codes-20758\"> </a></td><td>Wound - Chronic / Complex</td><td/></tr><tr><td style=\"white-space:nowrap\">20759<a name=\"example-referral-form-codes-20759\"> </a></td><td>Breast Reduction</td><td/></tr><tr><td style=\"white-space:nowrap\">20760<a name=\"example-referral-form-codes-20760\"> </a></td><td>Gynecomastia</td><td/></tr><tr><td style=\"white-space:nowrap\">20761<a name=\"example-referral-form-codes-20761\"> </a></td><td>Post-Mastectomy Reconstruction</td><td/></tr><tr><td style=\"white-space:nowrap\">20762<a name=\"example-referral-form-codes-20762\"> </a></td><td>Revision of Prior Breast-Surgery</td><td/></tr><tr><td style=\"white-space:nowrap\">20763<a name=\"example-referral-form-codes-20763\"> </a></td><td>Acute Burns</td><td/></tr><tr><td style=\"white-space:nowrap\">20764<a name=\"example-referral-form-codes-20764\"> </a></td><td>Burn Scar Contracture</td><td/></tr><tr><td style=\"white-space:nowrap\">20765<a name=\"example-referral-form-codes-20765\"> </a></td><td>Non-Healing Burn Wounds</td><td/></tr><tr><td style=\"white-space:nowrap\">20766<a name=\"example-referral-form-codes-20766\"> </a></td><td>Scar Revision</td><td/></tr><tr><td style=\"white-space:nowrap\">20767<a name=\"example-referral-form-codes-20767\"> </a></td><td>Date of Injury / Onset</td><td/></tr><tr><td style=\"white-space:nowrap\">20768<a name=\"example-referral-form-codes-20768\"> </a></td><td>Cleft Lip / Palate</td><td/></tr><tr><td style=\"white-space:nowrap\">20769<a name=\"example-referral-form-codes-20769\"> </a></td><td>Craniofacial Anomalies</td><td/></tr><tr><td style=\"white-space:nowrap\">20770<a name=\"example-referral-form-codes-20770\"> </a></td><td>Ear Anomalies</td><td/></tr><tr><td style=\"white-space:nowrap\">20771<a name=\"example-referral-form-codes-20771\"> </a></td><td>Hand Anomalies</td><td/></tr><tr><td style=\"white-space:nowrap\">20772<a name=\"example-referral-form-codes-20772\"> </a></td><td>Vascular Anomaly / Malformation</td><td/></tr><tr><td style=\"white-space:nowrap\">20773<a name=\"example-referral-form-codes-20773\"> </a></td><td>Acute Facial Fractures</td><td/></tr><tr><td style=\"white-space:nowrap\">20774<a name=\"example-referral-form-codes-20774\"> </a></td><td>Acute Soft Tissue Injuries</td><td/></tr><tr><td style=\"white-space:nowrap\">20775<a name=\"example-referral-form-codes-20775\"> </a></td><td>Reconstruction After Trauma</td><td/></tr><tr><td style=\"white-space:nowrap\">20776<a name=\"example-referral-form-codes-20776\"> </a></td><td>Chest (Top) Surgery</td><td/></tr><tr><td style=\"white-space:nowrap\">20777<a name=\"example-referral-form-codes-20777\"> </a></td><td>Facial Gender-Affirming Surgery</td><td/></tr><tr><td style=\"white-space:nowrap\">20778<a name=\"example-referral-form-codes-20778\"> </a></td><td>Genital (Bottom) Surgery</td><td/></tr><tr><td style=\"white-space:nowrap\">20780<a name=\"example-referral-form-codes-20780\"> </a></td><td>Fracture - Acute</td><td/></tr><tr><td style=\"white-space:nowrap\">20781<a name=\"example-referral-form-codes-20781\"> </a></td><td>Hand Osteoarthritis (with deformity/pain/loss of function)</td><td/></tr><tr><td style=\"white-space:nowrap\">20782<a name=\"example-referral-form-codes-20782\"> </a></td><td>Malunion / Non-union of Fractures</td><td/></tr><tr><td style=\"white-space:nowrap\">20783<a name=\"example-referral-form-codes-20783\"> </a></td><td>Tendon Injury - Acute</td><td/></tr><tr><td style=\"white-space:nowrap\">20785<a name=\"example-referral-form-codes-20785\"> </a></td><td>Brachial Plexus - Congenital Condition</td><td/></tr><tr><td style=\"white-space:nowrap\">20786<a name=\"example-referral-form-codes-20786\"> </a></td><td>Brachial Plexus - Traumatic Injury</td><td/></tr><tr><td style=\"white-space:nowrap\">20788<a name=\"example-referral-form-codes-20788\"> </a></td><td>Cubital Tunnel Syndrome</td><td/></tr><tr><td style=\"white-space:nowrap\">20789<a name=\"example-referral-form-codes-20789\"> </a></td><td>Peripheral Nerve Injury</td><td/></tr><tr><td style=\"white-space:nowrap\">20790<a name=\"example-referral-form-codes-20790\"> </a></td><td>Peripheral Nerve Tumour</td><td/></tr><tr><td style=\"white-space:nowrap\">20791<a name=\"example-referral-form-codes-20791\"> </a></td><td>Basal Cell Carcinoma</td><td/></tr><tr><td style=\"white-space:nowrap\">20792<a name=\"example-referral-form-codes-20792\"> </a></td><td>Squamous Cell Carcinoma</td><td/></tr><tr><td style=\"white-space:nowrap\">20794<a name=\"example-referral-form-codes-20794\"> </a></td><td>Benign or Symptomatic Lesion(s) (e.g. epidermal cysts, superficial lipomas)</td><td/></tr><tr><td style=\"white-space:nowrap\">20796<a name=\"example-referral-form-codes-20796\"> </a></td><td>Post-Cancer Reconstruction</td><td/></tr><tr><td style=\"white-space:nowrap\">20798<a name=\"example-referral-form-codes-20798\"> </a></td><td>Soft Tissue Sarcoma</td><td/></tr><tr><td style=\"white-space:nowrap\">20800<a name=\"example-referral-form-codes-20800\"> </a></td><td>Complex Wound (e.g., mixed etiology, non-healing, exposed structures)</td><td/></tr><tr><td style=\"white-space:nowrap\">20801<a name=\"example-referral-form-codes-20801\"> </a></td><td>Diabetic / Ischemic Foot Ulcer</td><td/></tr><tr><td style=\"white-space:nowrap\">20802<a name=\"example-referral-form-codes-20802\"> </a></td><td>Pressure Injury</td><td/></tr><tr><td style=\"white-space:nowrap\">20803<a name=\"example-referral-form-codes-20803\"> </a></td><td>Surgical Wound - Non-Healing</td><td/></tr><tr><td style=\"white-space:nowrap\">20804<a name=\"example-referral-form-codes-20804\"> </a></td><td>Venous Leg Ulcer</td><td/></tr><tr><td style=\"white-space:nowrap\">20805<a name=\"example-referral-form-codes-20805\"> </a></td><td>Anxiety or Panic Symptoms</td><td/></tr><tr><td style=\"white-space:nowrap\">20806<a name=\"example-referral-form-codes-20806\"> </a></td><td>Attention, Focus or Cognitive Processing Problems</td><td/></tr><tr><td style=\"white-space:nowrap\">20807<a name=\"example-referral-form-codes-20807\"> </a></td><td>Behavioural Addictions (e.g., gambling, gaming, internet use, sexual)</td><td/></tr><tr><td style=\"white-space:nowrap\">20808<a name=\"example-referral-form-codes-20808\"> </a></td><td>Bipolar / Mania Symptoms</td><td/></tr><tr><td style=\"white-space:nowrap\">20809<a name=\"example-referral-form-codes-20809\"> </a></td><td>Dementia-Related Behaviours</td><td/></tr><tr><td style=\"white-space:nowrap\">20810<a name=\"example-referral-form-codes-20810\"> </a></td><td>Depression Symptoms or Low Mood</td><td/></tr><tr><td style=\"white-space:nowrap\">20811<a name=\"example-referral-form-codes-20811\"> </a></td><td>Eating Concerns (e.g., restricted or binge eating)</td><td/></tr><tr><td style=\"white-space:nowrap\">20812<a name=\"example-referral-form-codes-20812\"> </a></td><td>Emotional Dysregulation (e.g., anger, aggression, mood swings)</td><td/></tr><tr><td style=\"white-space:nowrap\">20813<a name=\"example-referral-form-codes-20813\"> </a></td><td>Hyperactivity or Impulsivity</td><td/></tr><tr><td style=\"white-space:nowrap\">20814<a name=\"example-referral-form-codes-20814\"> </a></td><td>Intellectual Disability</td><td/></tr><tr><td style=\"white-space:nowrap\">20815<a name=\"example-referral-form-codes-20815\"> </a></td><td>Memory Concerns</td><td/></tr><tr><td style=\"white-space:nowrap\">20816<a name=\"example-referral-form-codes-20816\"> </a></td><td>Neurodevelopmental Concerns (e.g., autism-spectrum, ADHD)</td><td/></tr><tr><td style=\"white-space:nowrap\">20817<a name=\"example-referral-form-codes-20817\"> </a></td><td>Obsessions or Compulsions</td><td/></tr><tr><td style=\"white-space:nowrap\">20818<a name=\"example-referral-form-codes-20818\"> </a></td><td>Personality-Related Concerns (e.g., unstable relationships, chronic conflict with others)</td><td/></tr><tr><td style=\"white-space:nowrap\">20819<a name=\"example-referral-form-codes-20819\"> </a></td><td>Psychotic Symptoms (e.g., hallucinations, delusions, etc.)</td><td/></tr><tr><td style=\"white-space:nowrap\">20820<a name=\"example-referral-form-codes-20820\"> </a></td><td>Substance Use Concerns</td><td/></tr><tr><td style=\"white-space:nowrap\">20821<a name=\"example-referral-form-codes-20821\"> </a></td><td>Trauma-Related Symptoms / PTSD (e.g., hypervigilance, flashbacks)</td><td/></tr><tr><td style=\"white-space:nowrap\">20822<a name=\"example-referral-form-codes-20822\"> </a></td><td>Height (cm)</td><td/></tr><tr><td style=\"white-space:nowrap\">20823<a name=\"example-referral-form-codes-20823\"> </a></td><td>Weight (kg)</td><td/></tr><tr><td style=\"white-space:nowrap\">20824<a name=\"example-referral-form-codes-20824\"> </a></td><td>BMI</td><td/></tr><tr><td style=\"white-space:nowrap\">20825<a name=\"example-referral-form-codes-20825\"> </a></td><td>Homicidal Ideation / Threats</td><td/></tr><tr><td style=\"white-space:nowrap\">20826<a name=\"example-referral-form-codes-20826\"> </a></td><td>Self-Harm Behaviours</td><td/></tr><tr><td style=\"white-space:nowrap\">20827<a name=\"example-referral-form-codes-20827\"> </a></td><td>Suicidal Ideation or Attempt</td><td/></tr><tr><td style=\"white-space:nowrap\">20828<a name=\"example-referral-form-codes-20828\"> </a></td><td>Violence or Aggression</td><td/></tr><tr><td style=\"white-space:nowrap\">20829<a name=\"example-referral-form-codes-20829\"> </a></td><td>Housing Instability</td><td/></tr><tr><td style=\"white-space:nowrap\">20830<a name=\"example-referral-form-codes-20830\"> </a></td><td>Legal Involvement / History</td><td/></tr><tr><td style=\"white-space:nowrap\">20832<a name=\"example-referral-form-codes-20832\"> </a></td><td>Behavioural Addictions (e.g., gambling, internet use, gaming, sexual)</td><td/></tr><tr><td style=\"white-space:nowrap\">20836<a name=\"example-referral-form-codes-20836\"> </a></td><td>Difficulty coping with life stressors (e.g. grief, loss)</td><td/></tr><tr><td style=\"white-space:nowrap\">20841<a name=\"example-referral-form-codes-20841\"> </a></td><td>Psychotic Symptoms</td><td/></tr><tr><td style=\"white-space:nowrap\">20844<a name=\"example-referral-form-codes-20844\"> </a></td><td>Current Weight (kgs)</td><td/></tr><tr><td style=\"white-space:nowrap\">20845<a name=\"example-referral-form-codes-20845\"> </a></td><td>Current Weight (lbs)</td><td/></tr><tr><td style=\"white-space:nowrap\">20846<a name=\"example-referral-form-codes-20846\"> </a></td><td>Current Height (cm)</td><td/></tr><tr><td style=\"white-space:nowrap\">20848<a name=\"example-referral-form-codes-20848\"> </a></td><td>Blood Pressure</td><td/></tr><tr><td style=\"white-space:nowrap\">20849<a name=\"example-referral-form-codes-20849\"> </a></td><td>Heart Rate</td><td/></tr><tr><td style=\"white-space:nowrap\">20850<a name=\"example-referral-form-codes-20850\"> </a></td><td>Date of LMP</td><td/></tr><tr><td style=\"white-space:nowrap\">20851<a name=\"example-referral-form-codes-20851\"> </a></td><td>Food Intake Restrictions</td><td/></tr><tr><td style=\"white-space:nowrap\">20852<a name=\"example-referral-form-codes-20852\"> </a></td><td>Binge Eating</td><td/></tr><tr><td style=\"white-space:nowrap\">20853<a name=\"example-referral-form-codes-20853\"> </a></td><td>Induced Vomiting</td><td/></tr><tr><td style=\"white-space:nowrap\">20854<a name=\"example-referral-form-codes-20854\"> </a></td><td>Laxative Use</td><td/></tr><tr><td style=\"white-space:nowrap\">20855<a name=\"example-referral-form-codes-20855\"> </a></td><td>Exercise Quantity (per week)</td><td/></tr><tr><td style=\"white-space:nowrap\">20856<a name=\"example-referral-form-codes-20856\"> </a></td><td>Chewing and Spitting</td><td/></tr><tr><td style=\"white-space:nowrap\">20857<a name=\"example-referral-form-codes-20857\"> </a></td><td>Diet Medications</td><td/></tr><tr><td style=\"white-space:nowrap\">20858<a name=\"example-referral-form-codes-20858\"> </a></td><td>First Episode Psychosis</td><td/></tr><tr><td style=\"white-space:nowrap\">20859<a name=\"example-referral-form-codes-20859\"> </a></td><td>Case Management</td><td/></tr><tr><td style=\"white-space:nowrap\">20860<a name=\"example-referral-form-codes-20860\"> </a></td><td>Counselling / Psychotherapy Services</td><td/></tr><tr><td style=\"white-space:nowrap\">20861<a name=\"example-referral-form-codes-20861\"> </a></td><td>Psychiatric Consultation</td><td/></tr><tr><td style=\"white-space:nowrap\">20862<a name=\"example-referral-form-codes-20862\"> </a></td><td>Diagnostic Clarification</td><td/></tr><tr><td style=\"white-space:nowrap\">20863<a name=\"example-referral-form-codes-20863\"> </a></td><td>Interventional Psychiatry</td><td/></tr><tr><td style=\"white-space:nowrap\">20864<a name=\"example-referral-form-codes-20864\"> </a></td><td>Medication / Treatment Recommendations</td><td/></tr><tr><td style=\"white-space:nowrap\">20865<a name=\"example-referral-form-codes-20865\"> </a></td><td>Electroconvulsive therapy (ECT)</td><td/></tr><tr><td style=\"white-space:nowrap\">20866<a name=\"example-referral-form-codes-20866\"> </a></td><td>Repetitive Transcranial Magnetic Stimulation (rTMS)</td><td/></tr><tr><td style=\"white-space:nowrap\">20867<a name=\"example-referral-form-codes-20867\"> </a></td><td>Family Support Services</td><td/></tr><tr><td style=\"white-space:nowrap\">20868<a name=\"example-referral-form-codes-20868\"> </a></td><td>Peer Support Services</td><td/></tr><tr><td style=\"white-space:nowrap\">20869<a name=\"example-referral-form-codes-20869\"> </a></td><td>Supportive Housing</td><td/></tr><tr><td style=\"white-space:nowrap\">20870<a name=\"example-referral-form-codes-20870\"> </a></td><td>Bed-Based Addiction Treatment (formerly known as Residential Addiction Services)</td><td/></tr><tr><td style=\"white-space:nowrap\">20871<a name=\"example-referral-form-codes-20871\"> </a></td><td>Substance Use / Addiction Treatment</td><td/></tr><tr><td style=\"white-space:nowrap\">20872<a name=\"example-referral-form-codes-20872\"> </a></td><td>Stabilization on Opioid Agonist Therapy</td><td/></tr><tr><td style=\"white-space:nowrap\">20873<a name=\"example-referral-form-codes-20873\"> </a></td><td>Withdrawal Management</td><td/></tr><tr><td style=\"white-space:nowrap\">20874<a name=\"example-referral-form-codes-20874\"> </a></td><td>Court Support</td><td/></tr><tr><td style=\"white-space:nowrap\">20875<a name=\"example-referral-form-codes-20875\"> </a></td><td>Possible Safety Concern to Others (e.g. aggression, homicidal threats or ideation)</td><td/></tr><tr><td style=\"white-space:nowrap\">20879<a name=\"example-referral-form-codes-20879\"> </a></td><td>Legal Involvement / Court Orders (e.g. current charges, probation, parole, CTO/ORB conditions)</td><td/></tr><tr><td style=\"white-space:nowrap\">20880<a name=\"example-referral-form-codes-20880\"> </a></td><td>Bone and Joint Infections</td><td/></tr><tr><td style=\"white-space:nowrap\">20881<a name=\"example-referral-form-codes-20881\"> </a></td><td>Clostridioides difficile (C. diff)</td><td/></tr><tr><td style=\"white-space:nowrap\">20882<a name=\"example-referral-form-codes-20882\"> </a></td><td>Endocarditis</td><td/></tr><tr><td style=\"white-space:nowrap\">20883<a name=\"example-referral-form-codes-20883\"> </a></td><td>Fever of Unknown Origin (FUO)</td><td/></tr><tr><td style=\"white-space:nowrap\">20884<a name=\"example-referral-form-codes-20884\"> </a></td><td>HIV</td><td/></tr><tr><td style=\"white-space:nowrap\">20885<a name=\"example-referral-form-codes-20885\"> </a></td><td>Intra-Abdominal or Pelvic Infections</td><td/></tr><tr><td style=\"white-space:nowrap\">20886<a name=\"example-referral-form-codes-20886\"> </a></td><td>Lung Infections</td><td/></tr><tr><td style=\"white-space:nowrap\">20887<a name=\"example-referral-form-codes-20887\"> </a></td><td>Sexually Transmitted Infections (STIs)</td><td/></tr><tr><td style=\"white-space:nowrap\">20888<a name=\"example-referral-form-codes-20888\"> </a></td><td>Skin and Soft Tissue Infections (SSTIs)</td><td/></tr><tr><td style=\"white-space:nowrap\">20889<a name=\"example-referral-form-codes-20889\"> </a></td><td>Tick-borne Infections</td><td/></tr><tr><td style=\"white-space:nowrap\">20890<a name=\"example-referral-form-codes-20890\"> </a></td><td>Tropical and Parasitic Diseases</td><td/></tr><tr><td style=\"white-space:nowrap\">20891<a name=\"example-referral-form-codes-20891\"> </a></td><td>Tuberculosis (TB)</td><td/></tr><tr><td style=\"white-space:nowrap\">20892<a name=\"example-referral-form-codes-20892\"> </a></td><td>Urinary Tract Infection (UTIs)</td><td/></tr><tr><td style=\"white-space:nowrap\">20893<a name=\"example-referral-form-codes-20893\"> </a></td><td>Viral Hepatitis</td><td/></tr><tr><td style=\"white-space:nowrap\">20894<a name=\"example-referral-form-codes-20894\"> </a></td><td>Osteomyelitis</td><td/></tr><tr><td style=\"white-space:nowrap\">20895<a name=\"example-referral-form-codes-20895\"> </a></td><td>Prosthetic Joint Infection</td><td/></tr><tr><td style=\"white-space:nowrap\">20896<a name=\"example-referral-form-codes-20896\"> </a></td><td>Septic Arthritis</td><td/></tr><tr><td style=\"white-space:nowrap\">20897<a name=\"example-referral-form-codes-20897\"> </a></td><td>Spinal Infections</td><td/></tr><tr><td style=\"white-space:nowrap\">20898<a name=\"example-referral-form-codes-20898\"> </a></td><td>HIV - New Diagnosis</td><td/></tr><tr><td style=\"white-space:nowrap\">20899<a name=\"example-referral-form-codes-20899\"> </a></td><td>HIV - Ongoing Care</td><td/></tr><tr><td style=\"white-space:nowrap\">20900<a name=\"example-referral-form-codes-20900\"> </a></td><td>PrEP (Pre-Exposure Prophylaxis)</td><td/></tr><tr><td style=\"white-space:nowrap\">20901<a name=\"example-referral-form-codes-20901\"> </a></td><td>PEP (Post-Exposure Prophylaxis)</td><td/></tr><tr><td style=\"white-space:nowrap\">20903<a name=\"example-referral-form-codes-20903\"> </a></td><td>Cellulitis</td><td/></tr><tr><td style=\"white-space:nowrap\">20904<a name=\"example-referral-form-codes-20904\"> </a></td><td>Diabetic Foot Infection</td><td/></tr><tr><td style=\"white-space:nowrap\">20905<a name=\"example-referral-form-codes-20905\"> </a></td><td>Malaria</td><td/></tr><tr><td style=\"white-space:nowrap\">20906<a name=\"example-referral-form-codes-20906\"> </a></td><td>Active TB - Confirmed</td><td/></tr><tr><td style=\"white-space:nowrap\">20907<a name=\"example-referral-form-codes-20907\"> </a></td><td>Active TB -� Suspected</td><td/></tr><tr><td style=\"white-space:nowrap\">20908<a name=\"example-referral-form-codes-20908\"> </a></td><td>Latent TB Infection</td><td/></tr><tr><td style=\"white-space:nowrap\">20909<a name=\"example-referral-form-codes-20909\"> </a></td><td>Active drug and/or alcohol addiction</td><td/></tr><tr><td style=\"white-space:nowrap\">20910<a name=\"example-referral-form-codes-20910\"> </a></td><td>Active treatment for a major/life-threatening cancer (e.g. chemotherapy, radiation)</td><td/></tr><tr><td style=\"white-space:nowrap\">20911<a name=\"example-referral-form-codes-20911\"> </a></td><td>Significant psychiatric illness that is inadequately treated</td><td/></tr><tr><td style=\"white-space:nowrap\">20912<a name=\"example-referral-form-codes-20912\"> </a></td><td>Patient &gt;18 years old</td><td/></tr><tr><td style=\"white-space:nowrap\">20913<a name=\"example-referral-form-codes-20913\"> </a></td><td>Patient has an Ontario Health Card OR is a resident of Ontario and meets one of the following�</td><td/></tr><tr><td style=\"white-space:nowrap\">20915<a name=\"example-referral-form-codes-20915\"> </a></td><td>Weight (kgs)</td><td/></tr><tr><td style=\"white-space:nowrap\">20916<a name=\"example-referral-form-codes-20916\"> </a></td><td>Height (ft)</td><td/></tr><tr><td style=\"white-space:nowrap\">20917<a name=\"example-referral-form-codes-20917\"> </a></td><td>Height (in)</td><td/></tr><tr><td style=\"white-space:nowrap\">20918<a name=\"example-referral-form-codes-20918\"> </a></td><td>Weight (lbs)</td><td/></tr><tr><td style=\"white-space:nowrap\">20920<a name=\"example-referral-form-codes-20920\"> </a></td><td>Previously had bariatric surgery</td><td/></tr><tr><td style=\"white-space:nowrap\">20921<a name=\"example-referral-form-codes-20921\"> </a></td><td>Surgical complications</td><td/></tr><tr><td style=\"white-space:nowrap\">20922<a name=\"example-referral-form-codes-20922\"> </a></td><td>Weight regain (&gt;15% increase)</td><td/></tr><tr><td style=\"white-space:nowrap\">20923<a name=\"example-referral-form-codes-20923\"> </a></td><td>Idiopathic intracranial hypertension</td><td/></tr><tr><td style=\"white-space:nowrap\">20924<a name=\"example-referral-form-codes-20924\"> </a></td><td>Coronary heart disease</td><td/></tr><tr><td style=\"white-space:nowrap\">20925<a name=\"example-referral-form-codes-20925\"> </a></td><td>Type 2 diabetes</td><td/></tr><tr><td style=\"white-space:nowrap\">20927<a name=\"example-referral-form-codes-20927\"> </a></td><td>Diagnosed sleep apnea</td><td/></tr><tr><td style=\"white-space:nowrap\">20929<a name=\"example-referral-form-codes-20929\"> </a></td><td>Renal disease</td><td/></tr><tr><td style=\"white-space:nowrap\">20930<a name=\"example-referral-form-codes-20930\"> </a></td><td>Surgical Program</td><td/></tr><tr><td style=\"white-space:nowrap\">20931<a name=\"example-referral-form-codes-20931\"> </a></td><td>Medical Program</td><td/></tr><tr><td style=\"white-space:nowrap\">20932<a name=\"example-referral-form-codes-20932\"> </a></td><td>Pilot Metabolic Surgical Program at St. Joseph�s Healthcare Hamilton</td><td/></tr><tr><td style=\"white-space:nowrap\">20933<a name=\"example-referral-form-codes-20933\"> </a></td><td>Optometrist / Ophthalmologist</td><td/></tr><tr><td style=\"white-space:nowrap\">20934<a name=\"example-referral-form-codes-20934\"> </a></td><td>Primary Care</td><td/></tr><tr><td style=\"white-space:nowrap\">20935<a name=\"example-referral-form-codes-20935\"> </a></td><td>Clinical Optometry/Ophthalmology Report attached</td><td/></tr><tr><td style=\"white-space:nowrap\">20936<a name=\"example-referral-form-codes-20936\"> </a></td><td>Right Eye (OD)</td><td/></tr><tr><td style=\"white-space:nowrap\">20937<a name=\"example-referral-form-codes-20937\"> </a></td><td>Left Eye (OS)</td><td/></tr><tr><td style=\"white-space:nowrap\">20938<a name=\"example-referral-form-codes-20938\"> </a></td><td>Both Eyes (OU)</td><td/></tr><tr><td style=\"white-space:nowrap\">20939<a name=\"example-referral-form-codes-20939\"> </a></td><td>Optometry / Ophthalmology report attached including Best Corrected Visual Acuity (BCVA) and Past Ocular History</td><td/></tr><tr><td style=\"white-space:nowrap\">20940<a name=\"example-referral-form-codes-20940\"> </a></td><td>Right Eye</td><td/></tr><tr><td style=\"white-space:nowrap\">20941<a name=\"example-referral-form-codes-20941\"> </a></td><td>Right Eye BCVA 20/</td><td/></tr><tr><td style=\"white-space:nowrap\">20942<a name=\"example-referral-form-codes-20942\"> </a></td><td>Left Eye</td><td/></tr><tr><td style=\"white-space:nowrap\">20943<a name=\"example-referral-form-codes-20943\"> </a></td><td>Left Eye BCVA 20/</td><td/></tr><tr><td style=\"white-space:nowrap\">20944<a name=\"example-referral-form-codes-20944\"> </a></td><td>History of Ocular Pathologies</td><td/></tr><tr><td style=\"white-space:nowrap\">20945<a name=\"example-referral-form-codes-20945\"> </a></td><td>History of Diabetes</td><td/></tr><tr><td style=\"white-space:nowrap\">20946<a name=\"example-referral-form-codes-20946\"> </a></td><td>Right Eye (mmHg)</td><td/></tr><tr><td style=\"white-space:nowrap\">20947<a name=\"example-referral-form-codes-20947\"> </a></td><td>Left Eye (mmHg)</td><td/></tr><tr><td style=\"white-space:nowrap\">20948<a name=\"example-referral-form-codes-20948\"> </a></td><td>Does the patient wear contact lenses?</td><td/></tr><tr><td style=\"white-space:nowrap\">20949<a name=\"example-referral-form-codes-20949\"> </a></td><td>Soft</td><td/></tr><tr><td style=\"white-space:nowrap\">20950<a name=\"example-referral-form-codes-20950\"> </a></td><td>Rigid Gas Permeable</td><td/></tr><tr><td style=\"white-space:nowrap\">20951<a name=\"example-referral-form-codes-20951\"> </a></td><td>Does the patient wear prism in their spectacles?</td><td/></tr><tr><td style=\"white-space:nowrap\">20952<a name=\"example-referral-form-codes-20952\"> </a></td><td>Right Eye (prism)</td><td/></tr><tr><td style=\"white-space:nowrap\">20953<a name=\"example-referral-form-codes-20953\"> </a></td><td>Left Eye (prism)</td><td/></tr><tr><td style=\"white-space:nowrap\">20954<a name=\"example-referral-form-codes-20954\"> </a></td><td>Has the patient had previous corneal refractive surgery?</td><td/></tr><tr><td style=\"white-space:nowrap\">20955<a name=\"example-referral-form-codes-20955\"> </a></td><td>LASIK</td><td/></tr><tr><td style=\"white-space:nowrap\">20956<a name=\"example-referral-form-codes-20956\"> </a></td><td>PRK</td><td/></tr><tr><td style=\"white-space:nowrap\">20957<a name=\"example-referral-form-codes-20957\"> </a></td><td>RK</td><td/></tr><tr><td style=\"white-space:nowrap\">20958<a name=\"example-referral-form-codes-20958\"> </a></td><td>Has the patient had previous eye surgery or laser treatment?</td><td/></tr><tr><td style=\"white-space:nowrap\">20962<a name=\"example-referral-form-codes-20962\"> </a></td><td>Adrenal Gland Disorders</td><td/></tr><tr><td style=\"white-space:nowrap\">20963<a name=\"example-referral-form-codes-20963\"> </a></td><td>Diabetes</td><td/></tr><tr><td style=\"white-space:nowrap\">20964<a name=\"example-referral-form-codes-20964\"> </a></td><td>Dyslipidemia</td><td/></tr><tr><td style=\"white-space:nowrap\">20965<a name=\"example-referral-form-codes-20965\"> </a></td><td>Male Hypogonadism</td><td/></tr><tr><td style=\"white-space:nowrap\">20966<a name=\"example-referral-form-codes-20966\"> </a></td><td>Menopause</td><td/></tr><tr><td style=\"white-space:nowrap\">20967<a name=\"example-referral-form-codes-20967\"> </a></td><td>Oligomenorrhea / Amenorrhea</td><td/></tr><tr><td style=\"white-space:nowrap\">20968<a name=\"example-referral-form-codes-20968\"> </a></td><td>Osteoporosis</td><td/></tr><tr><td style=\"white-space:nowrap\">20969<a name=\"example-referral-form-codes-20969\"> </a></td><td>Parathyroid or Calcium Disorders</td><td/></tr><tr><td style=\"white-space:nowrap\">20970<a name=\"example-referral-form-codes-20970\"> </a></td><td>Pituitary Gland Disorders</td><td/></tr><tr><td style=\"white-space:nowrap\">20972<a name=\"example-referral-form-codes-20972\"> </a></td><td>Thyroid Disorders</td><td/></tr><tr><td style=\"white-space:nowrap\">20973<a name=\"example-referral-form-codes-20973\"> </a></td><td>Transgender (Gender Affirming Hormone Therapy)</td><td/></tr><tr><td style=\"white-space:nowrap\">20974<a name=\"example-referral-form-codes-20974\"> </a></td><td>Weight Management / Metabolic Disorders</td><td/></tr><tr><td style=\"white-space:nowrap\">20975<a name=\"example-referral-form-codes-20975\"> </a></td><td>Type 1 Diabetes</td><td/></tr><tr><td style=\"white-space:nowrap\">20978<a name=\"example-referral-form-codes-20978\"> </a></td><td>New</td><td/></tr><tr><td style=\"white-space:nowrap\">20979<a name=\"example-referral-form-codes-20979\"> </a></td><td>&lt;=6 months ago</td><td/></tr><tr><td style=\"white-space:nowrap\">20980<a name=\"example-referral-form-codes-20980\"> </a></td><td>&gt; 6 months ago</td><td/></tr><tr><td style=\"white-space:nowrap\">20977<a name=\"example-referral-form-codes-20977\"> </a></td><td>Patient on insulin</td><td/></tr><tr><td style=\"white-space:nowrap\">20981<a name=\"example-referral-form-codes-20981\"> </a></td><td>Chemotherapy - current or planned</td><td/></tr><tr><td style=\"white-space:nowrap\">20982<a name=\"example-referral-form-codes-20982\"> </a></td><td>Diabetic Ketoacidosis - recent hospitalization</td><td/></tr><tr><td style=\"white-space:nowrap\">20983<a name=\"example-referral-form-codes-20983\"> </a></td><td>Foot ulcer(s) - active or recurring</td><td/></tr><tr><td style=\"white-space:nowrap\">20984<a name=\"example-referral-form-codes-20984\"> </a></td><td>Glucocorticoids - high doses with recent or anticipated initiation</td><td/></tr><tr><td style=\"white-space:nowrap\">20985<a name=\"example-referral-form-codes-20985\"> </a></td><td>HbA1c &gt;10%</td><td/></tr><tr><td style=\"white-space:nowrap\">20986<a name=\"example-referral-form-codes-20986\"> </a></td><td>Hypoglycemia - severe and recent episode requiring assistance</td><td/></tr><tr><td style=\"white-space:nowrap\">20987<a name=\"example-referral-form-codes-20987\"> </a></td><td>Myocardial infarction or Stroke - recent event with inadequate control</td><td/></tr><tr><td style=\"white-space:nowrap\">20988<a name=\"example-referral-form-codes-20988\"> </a></td><td>Optimization required prior to procedure/surgery - Urgent</td><td/></tr><tr><td style=\"white-space:nowrap\">20989<a name=\"example-referral-form-codes-20989\"> </a></td><td>Transplant within last 6 months</td><td/></tr><tr><td style=\"white-space:nowrap\">20990<a name=\"example-referral-form-codes-20990\"> </a></td><td>HbA1C</td><td/></tr><tr><td style=\"white-space:nowrap\">20991<a name=\"example-referral-form-codes-20991\"> </a></td><td>Triglycerides &gt; 10 mmol/L</td><td/></tr><tr><td style=\"white-space:nowrap\">20992<a name=\"example-referral-form-codes-20992\"> </a></td><td>Atypical femur fracture</td><td/></tr><tr><td style=\"white-space:nowrap\">20993<a name=\"example-referral-form-codes-20993\"> </a></td><td>Fragility fracture - within last year</td><td/></tr><tr><td style=\"white-space:nowrap\">20994<a name=\"example-referral-form-codes-20994\"> </a></td><td>Glucocorticoids - Currently on prolonged high-dose</td><td/></tr><tr><td style=\"white-space:nowrap\">20995<a name=\"example-referral-form-codes-20995\"> </a></td><td>Glucocorticoids - Planned start of prolonged high-dose</td><td/></tr><tr><td style=\"white-space:nowrap\">20996<a name=\"example-referral-form-codes-20996\"> </a></td><td>Acromegaly suspected (clinically or high IGF-1/growth hormone)</td><td/></tr><tr><td style=\"white-space:nowrap\">20997<a name=\"example-referral-form-codes-20997\"> </a></td><td>Cushings disease suspected (clinically or lab testing)</td><td/></tr><tr><td style=\"white-space:nowrap\">20998<a name=\"example-referral-form-codes-20998\"> </a></td><td>Dysfunction - decreased pituitary function (include labs)</td><td/></tr><tr><td style=\"white-space:nowrap\">20999<a name=\"example-referral-form-codes-20999\"> </a></td><td>Prolactin &gt; 200 ug/L</td><td/></tr><tr><td style=\"white-space:nowrap\">21000<a name=\"example-referral-form-codes-21000\"> </a></td><td>Sellar lesion &gt; 1 cm - confirmed on MRI or CT</td><td/></tr><tr><td style=\"white-space:nowrap\">21001<a name=\"example-referral-form-codes-21001\"> </a></td><td>Visual fields compromised</td><td/></tr><tr><td style=\"white-space:nowrap\">21002<a name=\"example-referral-form-codes-21002\"> </a></td><td>Hyperthyroidism</td><td/></tr><tr><td style=\"white-space:nowrap\">21003<a name=\"example-referral-form-codes-21003\"> </a></td><td>Hypothyroidism</td><td/></tr><tr><td style=\"white-space:nowrap\">21004<a name=\"example-referral-form-codes-21004\"> </a></td><td>Thyroid Nodule</td><td/></tr><tr><td style=\"white-space:nowrap\">21005<a name=\"example-referral-form-codes-21005\"> </a></td><td>Thyroid Cancer</td><td/></tr><tr><td style=\"white-space:nowrap\">21006<a name=\"example-referral-form-codes-21006\"> </a></td><td>TSH</td><td/></tr><tr><td style=\"white-space:nowrap\">21007<a name=\"example-referral-form-codes-21007\"> </a></td><td>Site-Specific Suspicion of Cancer Presentations</td><td/></tr><tr><td style=\"white-space:nowrap\">21008<a name=\"example-referral-form-codes-21008\"> </a></td><td>Non-Site Specific Suspicion of Cancer Presentations</td><td/></tr><tr><td style=\"white-space:nowrap\">21009<a name=\"example-referral-form-codes-21009\"> </a></td><td>Breast</td><td/></tr><tr><td style=\"white-space:nowrap\">21010<a name=\"example-referral-form-codes-21010\"> </a></td><td>Chest / Lung</td><td/></tr><tr><td style=\"white-space:nowrap\">21011<a name=\"example-referral-form-codes-21011\"> </a></td><td>Genitourinary</td><td/></tr><tr><td style=\"white-space:nowrap\">21012<a name=\"example-referral-form-codes-21012\"> </a></td><td>Gynecologic</td><td/></tr><tr><td style=\"white-space:nowrap\">21013<a name=\"example-referral-form-codes-21013\"> </a></td><td>Head &amp; Neck</td><td/></tr><tr><td style=\"white-space:nowrap\">21014<a name=\"example-referral-form-codes-21014\"> </a></td><td>Hepatobiliary Pancreatic</td><td/></tr><tr><td style=\"white-space:nowrap\">21015<a name=\"example-referral-form-codes-21015\"> </a></td><td>Luminal Upper and Lower Gastrointestinal</td><td/></tr><tr><td style=\"white-space:nowrap\">21016<a name=\"example-referral-form-codes-21016\"> </a></td><td>Cutaneous Skin / Soft Tissue</td><td/></tr><tr><td style=\"white-space:nowrap\">21017<a name=\"example-referral-form-codes-21017\"> </a></td><td>Suspicious imaging for malignancy</td><td/></tr><tr><td style=\"white-space:nowrap\">21018<a name=\"example-referral-form-codes-21018\"> </a></td><td>Constitutional</td><td/></tr><tr><td style=\"white-space:nowrap\">21019<a name=\"example-referral-form-codes-21019\"> </a></td><td>Hematologic</td><td/></tr><tr><td style=\"white-space:nowrap\">21020<a name=\"example-referral-form-codes-21020\"> </a></td><td>Unintentional, unexplained =10% weight loss (6�12 months, or shorter if severe)</td><td/></tr><tr><td style=\"white-space:nowrap\">21021<a name=\"example-referral-form-codes-21021\"> </a></td><td>Persistent, unexplained fatigue, functionally impairing and not relieved by rest</td><td/></tr><tr><td style=\"white-space:nowrap\">21022<a name=\"example-referral-form-codes-21022\"> </a></td><td>Bone pain - long bone or spine</td><td/></tr><tr><td style=\"white-space:nowrap\">21023<a name=\"example-referral-form-codes-21023\"> </a></td><td>Persistent or unexplained abdominal pain</td><td/></tr><tr><td style=\"white-space:nowrap\">21024<a name=\"example-referral-form-codes-21024\"> </a></td><td>Persistent or unexplained pelvic pain</td><td/></tr><tr><td style=\"white-space:nowrap\">21025<a name=\"example-referral-form-codes-21025\"> </a></td><td>Subacute or progressive neurologic symptoms</td><td/></tr><tr><td style=\"white-space:nowrap\">21026<a name=\"example-referral-form-codes-21026\"> </a></td><td>Leukemia-pattern blood abnormalities</td><td/></tr><tr><td style=\"white-space:nowrap\">21027<a name=\"example-referral-form-codes-21027\"> </a></td><td>Lymphoma-pattern presentation</td><td/></tr><tr><td style=\"white-space:nowrap\">21028<a name=\"example-referral-form-codes-21028\"> </a></td><td>MDS/MPN/Myeloma-pattern presentation</td><td/></tr><tr><td style=\"white-space:nowrap\">21029<a name=\"example-referral-form-codes-21029\"> </a></td><td>Abnormal Imaging</td><td/></tr><tr><td style=\"white-space:nowrap\">21036<a name=\"example-referral-form-codes-21036\"> </a></td><td>Medical Issue Affecting Pregnancy</td><td/></tr><tr><td style=\"white-space:nowrap\">21037<a name=\"example-referral-form-codes-21037\"> </a></td><td>Perioperative Assessment</td><td/></tr><tr><td style=\"white-space:nowrap\">21039<a name=\"example-referral-form-codes-21039\"> </a></td><td>Thyroid</td><td/></tr><tr><td style=\"white-space:nowrap\">21040<a name=\"example-referral-form-codes-21040\"> </a></td><td>Unexplained Weight Loss</td><td/></tr><tr><td style=\"white-space:nowrap\">21041<a name=\"example-referral-form-codes-21041\"> </a></td><td>Anemia</td><td/></tr><tr><td style=\"white-space:nowrap\">21042<a name=\"example-referral-form-codes-21042\"> </a></td><td>Arrhythmia</td><td/></tr><tr><td style=\"white-space:nowrap\">21046<a name=\"example-referral-form-codes-21046\"> </a></td><td>Preconception</td><td/></tr><tr><td style=\"white-space:nowrap\">21047<a name=\"example-referral-form-codes-21047\"> </a></td><td>Thrombocytopenia</td><td/></tr><tr><td style=\"white-space:nowrap\">21049<a name=\"example-referral-form-codes-21049\"> </a></td><td>Venous Thromboembolism</td><td/></tr><tr><td style=\"white-space:nowrap\">21050<a name=\"example-referral-form-codes-21050\"> </a></td><td>Behavioural</td><td/></tr><tr><td style=\"white-space:nowrap\">21051<a name=\"example-referral-form-codes-21051\"> </a></td><td>Cardiac</td><td/></tr><tr><td style=\"white-space:nowrap\">21052<a name=\"example-referral-form-codes-21052\"> </a></td><td>Developmental / Growth</td><td/></tr><tr><td style=\"white-space:nowrap\">21053<a name=\"example-referral-form-codes-21053\"> </a></td><td>Dermatologic</td><td/></tr><tr><td style=\"white-space:nowrap\">21054<a name=\"example-referral-form-codes-21054\"> </a></td><td>Endocrine</td><td/></tr><tr><td style=\"white-space:nowrap\">21055<a name=\"example-referral-form-codes-21055\"> </a></td><td>Gastrointestinal</td><td/></tr><tr><td style=\"white-space:nowrap\">21056<a name=\"example-referral-form-codes-21056\"> </a></td><td>Genetic</td><td/></tr><tr><td style=\"white-space:nowrap\">21058<a name=\"example-referral-form-codes-21058\"> </a></td><td>Musculoskeletal / Rheumatologic</td><td/></tr><tr><td style=\"white-space:nowrap\">21059<a name=\"example-referral-form-codes-21059\"> </a></td><td>Neonatal</td><td/></tr><tr><td style=\"white-space:nowrap\">21060<a name=\"example-referral-form-codes-21060\"> </a></td><td>Mental Health</td><td/></tr><tr><td style=\"white-space:nowrap\">21061<a name=\"example-referral-form-codes-21061\"> </a></td><td>Neurologic</td><td/></tr><tr><td style=\"white-space:nowrap\">21062<a name=\"example-referral-form-codes-21062\"> </a></td><td>Renal</td><td/></tr><tr><td style=\"white-space:nowrap\">21063<a name=\"example-referral-form-codes-21063\"> </a></td><td>Respiratory</td><td/></tr><tr><td style=\"white-space:nowrap\">21064<a name=\"example-referral-form-codes-21064\"> </a></td><td>Attention Deficit Hyperactivity Disorder (ADHD)</td><td/></tr><tr><td style=\"white-space:nowrap\">21065<a name=\"example-referral-form-codes-21065\"> </a></td><td>Autism Spectrum Disorder (ASD)</td><td/></tr><tr><td style=\"white-space:nowrap\">21067<a name=\"example-referral-form-codes-21067\"> </a></td><td>Palpitations</td><td/></tr><tr><td style=\"white-space:nowrap\">21069<a name=\"example-referral-form-codes-21069\"> </a></td><td>Fine Motor Delay</td><td/></tr><tr><td style=\"white-space:nowrap\">21070<a name=\"example-referral-form-codes-21070\"> </a></td><td>Gross Motor Delay</td><td/></tr><tr><td style=\"white-space:nowrap\">21071<a name=\"example-referral-form-codes-21071\"> </a></td><td>Growth Concerns</td><td/></tr><tr><td style=\"white-space:nowrap\">21072<a name=\"example-referral-form-codes-21072\"> </a></td><td>Learning Disability / Learning Problem</td><td/></tr><tr><td style=\"white-space:nowrap\">21073<a name=\"example-referral-form-codes-21073\"> </a></td><td>Speech or Language Disorder</td><td/></tr><tr><td style=\"white-space:nowrap\">21074<a name=\"example-referral-form-codes-21074\"> </a></td><td>Failure to Thrive</td><td/></tr><tr><td style=\"white-space:nowrap\">21075<a name=\"example-referral-form-codes-21075\"> </a></td><td>Atopic Dermatitis</td><td/></tr><tr><td style=\"white-space:nowrap\">21076<a name=\"example-referral-form-codes-21076\"> </a></td><td>Birth Mark</td><td/></tr><tr><td style=\"white-space:nowrap\">21077<a name=\"example-referral-form-codes-21077\"> </a></td><td>Hemangioma</td><td/></tr><tr><td style=\"white-space:nowrap\">21078<a name=\"example-referral-form-codes-21078\"> </a></td><td>Rash</td><td/></tr><tr><td style=\"white-space:nowrap\">21080<a name=\"example-referral-form-codes-21080\"> </a></td><td>Gender Dysphoria</td><td/></tr><tr><td style=\"white-space:nowrap\">21081<a name=\"example-referral-form-codes-21081\"> </a></td><td>Menstrual Irregularities</td><td/></tr><tr><td style=\"white-space:nowrap\">21082<a name=\"example-referral-form-codes-21082\"> </a></td><td>Obesity</td><td/></tr><tr><td style=\"white-space:nowrap\">21083<a name=\"example-referral-form-codes-21083\"> </a></td><td>Premature or Delayed Puberty</td><td/></tr><tr><td style=\"white-space:nowrap\">21084<a name=\"example-referral-form-codes-21084\"> </a></td><td>Short Stature</td><td/></tr><tr><td style=\"white-space:nowrap\">21085<a name=\"example-referral-form-codes-21085\"> </a></td><td>Thyroid Dysfunction</td><td/></tr><tr><td style=\"white-space:nowrap\">21086<a name=\"example-referral-form-codes-21086\"> </a></td><td>Abdominal Pain</td><td/></tr><tr><td style=\"white-space:nowrap\">21089<a name=\"example-referral-form-codes-21089\"> </a></td><td>Encopresis</td><td/></tr><tr><td style=\"white-space:nowrap\">21090<a name=\"example-referral-form-codes-21090\"> </a></td><td>GERD</td><td/></tr><tr><td style=\"white-space:nowrap\">21091<a name=\"example-referral-form-codes-21091\"> </a></td><td>Dysmorphic / Syndromic</td><td/></tr><tr><td style=\"white-space:nowrap\">21092<a name=\"example-referral-form-codes-21092\"> </a></td><td>Family History of Known Genetic Disorder</td><td/></tr><tr><td style=\"white-space:nowrap\">21093<a name=\"example-referral-form-codes-21093\"> </a></td><td>Trisomy 21</td><td/></tr><tr><td style=\"white-space:nowrap\">21096<a name=\"example-referral-form-codes-21096\"> </a></td><td>Neutropenia</td><td/></tr><tr><td style=\"white-space:nowrap\">21098<a name=\"example-referral-form-codes-21098\"> </a></td><td>Gait Concerns</td><td/></tr><tr><td style=\"white-space:nowrap\">21099<a name=\"example-referral-form-codes-21099\"> </a></td><td>Joint / Bone Pain</td><td/></tr><tr><td style=\"white-space:nowrap\">21100<a name=\"example-referral-form-codes-21100\"> </a></td><td>Joint Swelling</td><td/></tr><tr><td style=\"white-space:nowrap\">21101<a name=\"example-referral-form-codes-21101\"> </a></td><td>Scoliosis</td><td/></tr><tr><td style=\"white-space:nowrap\">21102<a name=\"example-referral-form-codes-21102\"> </a></td><td>Feeding Difficulties</td><td/></tr><tr><td style=\"white-space:nowrap\">21103<a name=\"example-referral-form-codes-21103\"> </a></td><td>Hyperbilirubinemia</td><td/></tr><tr><td style=\"white-space:nowrap\">21104<a name=\"example-referral-form-codes-21104\"> </a></td><td>Low Birth Weight</td><td/></tr><tr><td style=\"white-space:nowrap\">21105<a name=\"example-referral-form-codes-21105\"> </a></td><td>Neonatal Seizures</td><td/></tr><tr><td style=\"white-space:nowrap\">21106<a name=\"example-referral-form-codes-21106\"> </a></td><td>Prematurity</td><td/></tr><tr><td style=\"white-space:nowrap\">21107<a name=\"example-referral-form-codes-21107\"> </a></td><td>Anxiety</td><td/></tr><tr><td style=\"white-space:nowrap\">21108<a name=\"example-referral-form-codes-21108\"> </a></td><td>Depression</td><td/></tr><tr><td style=\"white-space:nowrap\">21109<a name=\"example-referral-form-codes-21109\"> </a></td><td>Epilepsy</td><td/></tr><tr><td style=\"white-space:nowrap\">21110<a name=\"example-referral-form-codes-21110\"> </a></td><td>Febrile Seizure(s)</td><td/></tr><tr><td style=\"white-space:nowrap\">21111<a name=\"example-referral-form-codes-21111\"> </a></td><td>Headaches</td><td/></tr><tr><td style=\"white-space:nowrap\">21112<a name=\"example-referral-form-codes-21112\"> </a></td><td>Tics</td><td/></tr><tr><td style=\"white-space:nowrap\">21113<a name=\"example-referral-form-codes-21113\"> </a></td><td>Enuresis</td><td/></tr><tr><td style=\"white-space:nowrap\">21115<a name=\"example-referral-form-codes-21115\"> </a></td><td>UTI(s)</td><td/></tr><tr><td style=\"white-space:nowrap\">21117<a name=\"example-referral-form-codes-21117\"> </a></td><td>Persistent Cough</td><td/></tr><tr><td style=\"white-space:nowrap\">21118<a name=\"example-referral-form-codes-21118\"> </a></td><td>Upper and Lower Respiratory Issues</td><td/></tr><tr><td style=\"white-space:nowrap\">21119<a name=\"example-referral-form-codes-21119\"> </a></td><td>Abdominal Lesion / Mass</td><td/></tr><tr><td style=\"white-space:nowrap\">21120<a name=\"example-referral-form-codes-21120\"> </a></td><td>Abdominal Pain NYD - Chronic</td><td/></tr><tr><td style=\"white-space:nowrap\">21121<a name=\"example-referral-form-codes-21121\"> </a></td><td>Anorectal / Perianal Conditions</td><td/></tr><tr><td style=\"white-space:nowrap\">21122<a name=\"example-referral-form-codes-21122\"> </a></td><td>Breast Conditions</td><td/></tr><tr><td style=\"white-space:nowrap\">21123<a name=\"example-referral-form-codes-21123\"> </a></td><td>Colonoscopy - Screening / Surveillance</td><td/></tr><tr><td style=\"white-space:nowrap\">21124<a name=\"example-referral-form-codes-21124\"> </a></td><td>Colorectal Conditions</td><td/></tr><tr><td style=\"white-space:nowrap\">21126<a name=\"example-referral-form-codes-21126\"> </a></td><td>Hepatobiliary &amp; Pancreatic Conditions</td><td/></tr><tr><td style=\"white-space:nowrap\">21127<a name=\"example-referral-form-codes-21127\"> </a></td><td>Hernias</td><td/></tr><tr><td style=\"white-space:nowrap\">21128<a name=\"example-referral-form-codes-21128\"> </a></td><td>Rectal Bleeding NYD</td><td/></tr><tr><td style=\"white-space:nowrap\">21129<a name=\"example-referral-form-codes-21129\"> </a></td><td>Skin &amp; Soft-Tissue Lesions</td><td/></tr><tr><td style=\"white-space:nowrap\">21130<a name=\"example-referral-form-codes-21130\"> </a></td><td>Upper GI Tract Disorder</td><td/></tr><tr><td style=\"white-space:nowrap\">21131<a name=\"example-referral-form-codes-21131\"> </a></td><td>Anal Region Disorders (e.g. fissures, fistulas, hemorrhoids)</td><td/></tr><tr><td style=\"white-space:nowrap\">21132<a name=\"example-referral-form-codes-21132\"> </a></td><td>Fecal Incontinence</td><td/></tr><tr><td style=\"white-space:nowrap\">21133<a name=\"example-referral-form-codes-21133\"> </a></td><td>Pilonidal Disease</td><td/></tr><tr><td style=\"white-space:nowrap\">21134<a name=\"example-referral-form-codes-21134\"> </a></td><td>Rectal Prolapse</td><td/></tr><tr><td style=\"white-space:nowrap\">21135<a name=\"example-referral-form-codes-21135\"> </a></td><td>Breast Lump</td><td/></tr><tr><td style=\"white-space:nowrap\">21138<a name=\"example-referral-form-codes-21138\"> </a></td><td>Screening</td><td/></tr><tr><td style=\"white-space:nowrap\">21139<a name=\"example-referral-form-codes-21139\"> </a></td><td>Surveillance</td><td/></tr><tr><td style=\"white-space:nowrap\">21140<a name=\"example-referral-form-codes-21140\"> </a></td><td>Colorectal Lesion / Mass (e.g. polyp, cancer)</td><td/></tr><tr><td style=\"white-space:nowrap\">21141<a name=\"example-referral-form-codes-21141\"> </a></td><td>Diverticulitis</td><td/></tr><tr><td style=\"white-space:nowrap\">21142<a name=\"example-referral-form-codes-21142\"> </a></td><td>Inflammatory Bowel Disease</td><td/></tr><tr><td style=\"white-space:nowrap\">21144<a name=\"example-referral-form-codes-21144\"> </a></td><td>Parathyroid Disease</td><td/></tr><tr><td style=\"white-space:nowrap\">21145<a name=\"example-referral-form-codes-21145\"> </a></td><td>Thyroid Mass / Enlargement</td><td/></tr><tr><td style=\"white-space:nowrap\">21146<a name=\"example-referral-form-codes-21146\"> </a></td><td>Gallbladder / Gallstone Disease</td><td/></tr><tr><td style=\"white-space:nowrap\">21147<a name=\"example-referral-form-codes-21147\"> </a></td><td>Gallbladder Polyp / Mass</td><td/></tr><tr><td style=\"white-space:nowrap\">21148<a name=\"example-referral-form-codes-21148\"> </a></td><td>Liver Lesion / Mass</td><td/></tr><tr><td style=\"white-space:nowrap\">21149<a name=\"example-referral-form-codes-21149\"> </a></td><td>Pancreatic Lesion / Mass</td><td/></tr><tr><td style=\"white-space:nowrap\">21150<a name=\"example-referral-form-codes-21150\"> </a></td><td>Inguinal Hernia</td><td/></tr><tr><td style=\"white-space:nowrap\">21151<a name=\"example-referral-form-codes-21151\"> </a></td><td>Umbilical / Epigastric Hernia</td><td/></tr><tr><td style=\"white-space:nowrap\">21152<a name=\"example-referral-form-codes-21152\"> </a></td><td>Ventral / Incisional Hernia</td><td/></tr><tr><td style=\"white-space:nowrap\">21153<a name=\"example-referral-form-codes-21153\"> </a></td><td>Benign Lesion (e.g. lipoma, cyst)</td><td/></tr><tr><td style=\"white-space:nowrap\">21154<a name=\"example-referral-form-codes-21154\"> </a></td><td>Lymph Node</td><td/></tr><tr><td style=\"white-space:nowrap\">21156<a name=\"example-referral-form-codes-21156\"> </a></td><td>First-degree relative(s) with colorectal cancer</td><td/></tr><tr><td style=\"white-space:nowrap\">21157<a name=\"example-referral-form-codes-21157\"> </a></td><td>Hereditary cancer syndrome</td><td/></tr><tr><td style=\"white-space:nowrap\">21158<a name=\"example-referral-form-codes-21158\"> </a></td><td>First-degree relative(s) with documented advanced polyps before age 60</td><td/></tr><tr><td style=\"white-space:nowrap\">21159<a name=\"example-referral-form-codes-21159\"> </a></td><td>Frailty or Health / Social Complexity</td><td/></tr><tr><td style=\"white-space:nowrap\">21160<a name=\"example-referral-form-codes-21160\"> </a></td><td>Goals of Care and Future Planning</td><td/></tr><tr><td style=\"white-space:nowrap\">21161<a name=\"example-referral-form-codes-21161\"> </a></td><td>Medication Review / Advice</td><td/></tr><tr><td style=\"white-space:nowrap\">21162<a name=\"example-referral-form-codes-21162\"> </a></td><td>Mind or Mood</td><td/></tr><tr><td style=\"white-space:nowrap\">21163<a name=\"example-referral-form-codes-21163\"> </a></td><td>Mobility</td><td/></tr><tr><td style=\"white-space:nowrap\">21164<a name=\"example-referral-form-codes-21164\"> </a></td><td>Caregiver Burden</td><td/></tr><tr><td style=\"white-space:nowrap\">21165<a name=\"example-referral-form-codes-21165\"> </a></td><td>Complex Psychosocial / Economic</td><td/></tr><tr><td style=\"white-space:nowrap\">21166<a name=\"example-referral-form-codes-21166\"> </a></td><td>Frailty</td><td/></tr><tr><td style=\"white-space:nowrap\">21167<a name=\"example-referral-form-codes-21167\"> </a></td><td>Generalized Functional Decline</td><td/></tr><tr><td style=\"white-space:nowrap\">21168<a name=\"example-referral-form-codes-21168\"> </a></td><td>Multi-morbidity</td><td/></tr><tr><td style=\"white-space:nowrap\">21172<a name=\"example-referral-form-codes-21172\"> </a></td><td>Cognitive Impairment</td><td/></tr><tr><td style=\"white-space:nowrap\">21173<a name=\"example-referral-form-codes-21173\"> </a></td><td>Mood Disorder</td><td/></tr><tr><td style=\"white-space:nowrap\">21174<a name=\"example-referral-form-codes-21174\"> </a></td><td>Responsive Behaviours (e.g. aggression, wandering etc...)</td><td/></tr><tr><td style=\"white-space:nowrap\">21175<a name=\"example-referral-form-codes-21175\"> </a></td><td>Psychotic Symptoms (e.g. hallucinations, delusions, etc...)</td><td/></tr><tr><td style=\"white-space:nowrap\">21176<a name=\"example-referral-form-codes-21176\"> </a></td><td>Impaired Gait / Balance</td><td/></tr><tr><td style=\"white-space:nowrap\">21177<a name=\"example-referral-form-codes-21177\"> </a></td><td>Falls</td><td/></tr><tr><td style=\"white-space:nowrap\">21198<a name=\"example-referral-form-codes-21198\"> </a></td><td>General Neurosurgery</td><td/></tr><tr><td style=\"white-space:nowrap\">21199<a name=\"example-referral-form-codes-21199\"> </a></td><td>Cranial / Brain &amp; Skull Lesions</td><td/></tr><tr><td style=\"white-space:nowrap\">21201<a name=\"example-referral-form-codes-21201\"> </a></td><td>Hydrocephalus / Cerebrospinal Fluid (CSF)</td><td/></tr><tr><td style=\"white-space:nowrap\">21202<a name=\"example-referral-form-codes-21202\"> </a></td><td>Neurovascular</td><td/></tr><tr><td style=\"white-space:nowrap\">21205<a name=\"example-referral-form-codes-21205\"> </a></td><td>Cranial Arachnoid Cyst</td><td/></tr><tr><td style=\"white-space:nowrap\">21206<a name=\"example-referral-form-codes-21206\"> </a></td><td>Chiari Malformation</td><td/></tr><tr><td style=\"white-space:nowrap\">21207<a name=\"example-referral-form-codes-21207\"> </a></td><td>Microvascular Decompression - Trigeminal Neuralgia, Hemifacial Spasm</td><td/></tr><tr><td style=\"white-space:nowrap\">21208<a name=\"example-referral-form-codes-21208\"> </a></td><td>Neurosurgery Spine (intradural pathology) - Syrinx, Arachnoid Cyst, Tumour, Tethered Cord, etc.</td><td/></tr><tr><td style=\"white-space:nowrap\">21209<a name=\"example-referral-form-codes-21209\"> </a></td><td>Subdural Hematoma - Chronic</td><td/></tr><tr><td style=\"white-space:nowrap\">21210<a name=\"example-referral-form-codes-21210\"> </a></td><td>Brain Tumour - Primary</td><td/></tr><tr><td style=\"white-space:nowrap\">21211<a name=\"example-referral-form-codes-21211\"> </a></td><td>Brain Tumour - Metastatic</td><td/></tr><tr><td style=\"white-space:nowrap\">21212<a name=\"example-referral-form-codes-21212\"> </a></td><td>Meningioma</td><td/></tr><tr><td style=\"white-space:nowrap\">21213<a name=\"example-referral-form-codes-21213\"> </a></td><td>Pituitary / Sellar Lesion</td><td/></tr><tr><td style=\"white-space:nowrap\">21214<a name=\"example-referral-form-codes-21214\"> </a></td><td>Skull Base / Cranial Nerve Tumour</td><td/></tr><tr><td style=\"white-space:nowrap\">21215<a name=\"example-referral-form-codes-21215\"> </a></td><td>Epilepsy Surgery Assessment</td><td/></tr><tr><td style=\"white-space:nowrap\">21216<a name=\"example-referral-form-codes-21216\"> </a></td><td>Neuromodulation for Pain</td><td/></tr><tr><td style=\"white-space:nowrap\">21217<a name=\"example-referral-form-codes-21217\"> </a></td><td>Parkinson's - Deep Brain Stimulation Surgical Assessment</td><td/></tr><tr><td style=\"white-space:nowrap\">21218<a name=\"example-referral-form-codes-21218\"> </a></td><td>Other Movement Disorder - Deep Brain Stimulation Surgical Assessment</td><td/></tr><tr><td style=\"white-space:nowrap\">21219<a name=\"example-referral-form-codes-21219\"> </a></td><td>CSF Shunt Assessment (Insertion / Revision / Removal)</td><td/></tr><tr><td style=\"white-space:nowrap\">21220<a name=\"example-referral-form-codes-21220\"> </a></td><td>Hydrocephalus - Normal Pressure (NPH)</td><td/></tr><tr><td style=\"white-space:nowrap\">21221<a name=\"example-referral-form-codes-21221\"> </a></td><td>Hydrocephalus - Other (non-NPH)</td><td/></tr><tr><td style=\"white-space:nowrap\">21222<a name=\"example-referral-form-codes-21222\"> </a></td><td>Arteriovenous Malformation (AVM) / Dural AV Fistula</td><td/></tr><tr><td style=\"white-space:nowrap\">21223<a name=\"example-referral-form-codes-21223\"> </a></td><td>Brain Aneurysm - Unruptured</td><td/></tr><tr><td style=\"white-space:nowrap\">21224<a name=\"example-referral-form-codes-21224\"> </a></td><td>Carotid Stenosis</td><td/></tr><tr><td style=\"white-space:nowrap\">21225<a name=\"example-referral-form-codes-21225\"> </a></td><td>Cavernous Malformation</td><td/></tr><tr><td style=\"white-space:nowrap\">21226<a name=\"example-referral-form-codes-21226\"> </a></td><td>Brachial Plexus Injury/Lesion</td><td/></tr><tr><td style=\"white-space:nowrap\">21229<a name=\"example-referral-form-codes-21229\"> </a></td><td>Ulnar Nerve Entrapment</td><td/></tr><tr><td style=\"white-space:nowrap\">21230<a name=\"example-referral-form-codes-21230\"> </a></td><td>Other Focal Nerve Entrapment (radial, peroneal, etc.)</td><td/></tr><tr><td style=\"white-space:nowrap\">21231<a name=\"example-referral-form-codes-21231\"> </a></td><td>Cervical</td><td/></tr><tr><td style=\"white-space:nowrap\">21232<a name=\"example-referral-form-codes-21232\"> </a></td><td>Thoracic</td><td/></tr><tr><td style=\"white-space:nowrap\">21233<a name=\"example-referral-form-codes-21233\"> </a></td><td>Lumbar</td><td/></tr><tr><td style=\"white-space:nowrap\">21234<a name=\"example-referral-form-codes-21234\"> </a></td><td>Congenital Hemolytic Anemia</td><td/></tr><tr><td style=\"white-space:nowrap\">21236<a name=\"example-referral-form-codes-21236\"> </a></td><td>Hereditary Spherocytosis</td><td/></tr><tr><td style=\"white-space:nowrap\">21238<a name=\"example-referral-form-codes-21238\"> </a></td><td>Thalassemia</td><td/></tr><tr><td style=\"white-space:nowrap\">21239<a name=\"example-referral-form-codes-21239\"> </a></td><td>Uncomplicated Hemoglobinopathy Trait (Sickle Trait, Thalassemia Trait)</td><td/></tr><tr><td style=\"white-space:nowrap\">21240<a name=\"example-referral-form-codes-21240\"> </a></td><td>Aneurysm / Dissection - Asymptomatic</td><td/></tr><tr><td style=\"white-space:nowrap\">21241<a name=\"example-referral-form-codes-21241\"> </a></td><td>Carotid Stenosis - Asymptomatic</td><td/></tr><tr><td style=\"white-space:nowrap\">21242<a name=\"example-referral-form-codes-21242\"> </a></td><td>Diabetic Foot Ulcers</td><td/></tr><tr><td style=\"white-space:nowrap\">21243<a name=\"example-referral-form-codes-21243\"> </a></td><td>Peripheral Arterial Disease</td><td/></tr><tr><td style=\"white-space:nowrap\">21244<a name=\"example-referral-form-codes-21244\"> </a></td><td>Venous Disease</td><td/></tr><tr><td style=\"white-space:nowrap\">21245<a name=\"example-referral-form-codes-21245\"> </a></td><td>Abdominal Aortic Aneurysm (AAA)</td><td/></tr><tr><td style=\"white-space:nowrap\">21246<a name=\"example-referral-form-codes-21246\"> </a></td><td>Descending Thoracic Aortic Aneurysm, Pathology or Dissection</td><td/></tr><tr><td style=\"white-space:nowrap\">21247<a name=\"example-referral-form-codes-21247\"> </a></td><td>Other Aneurysm (e.g. Popliteal, Visceral, Renal)</td><td/></tr><tr><td style=\"white-space:nowrap\">21248<a name=\"example-referral-form-codes-21248\"> </a></td><td>With high risk features (e.g. ulcerated / irregular plaque, plaque hemorrhage, contralateral ICA occlusion, progressive stenosis, young patients)</td><td/></tr><tr><td style=\"white-space:nowrap\">21249<a name=\"example-referral-form-codes-21249\"> </a></td><td>Symptoms within 2 weeks to 6 months and more than 50% ICA stenosis</td><td/></tr><tr><td style=\"white-space:nowrap\">21250<a name=\"example-referral-form-codes-21250\"> </a></td><td>Without high risk features, more than 50% ICA stenosis and no symptoms within 6 months</td><td/></tr><tr><td style=\"white-space:nowrap\">21251<a name=\"example-referral-form-codes-21251\"> </a></td><td>Ulcer</td><td/></tr><tr><td style=\"white-space:nowrap\">21252<a name=\"example-referral-form-codes-21252\"> </a></td><td>Active infection</td><td/></tr><tr><td style=\"white-space:nowrap\">21254<a name=\"example-referral-form-codes-21254\"> </a></td><td>Asymptomatic</td><td/></tr><tr><td style=\"white-space:nowrap\">21255<a name=\"example-referral-form-codes-21255\"> </a></td><td>Claudication</td><td/></tr><tr><td style=\"white-space:nowrap\">21256<a name=\"example-referral-form-codes-21256\"> </a></td><td>Chronic Limb-Threatening Ischemia (e.g. rest pain, tissue loss)</td><td/></tr><tr><td style=\"white-space:nowrap\">21257<a name=\"example-referral-form-codes-21257\"> </a></td><td>Upper Extremity Disease</td><td/></tr><tr><td style=\"white-space:nowrap\">21258<a name=\"example-referral-form-codes-21258\"> </a></td><td>Varicose Veins with complication</td><td/></tr><tr><td style=\"white-space:nowrap\">21259<a name=\"example-referral-form-codes-21259\"> </a></td><td>Varicose Veins without complication</td><td/></tr><tr><td style=\"white-space:nowrap\">21260<a name=\"example-referral-form-codes-21260\"> </a></td><td>Upper Extremity Venous Disease</td><td/></tr><tr><td style=\"white-space:nowrap\">21261<a name=\"example-referral-form-codes-21261\"> </a></td><td>Currently Pregnant</td><td/></tr><tr><td style=\"white-space:nowrap\">21262<a name=\"example-referral-form-codes-21262\"> </a></td><td>Currently Pregnant or &lt;12 Months Postpartum</td><td/></tr><tr><td style=\"white-space:nowrap\">21264<a name=\"example-referral-form-codes-21264\"> </a></td><td>Second Opinion</td><td/></tr><tr><td style=\"white-space:nowrap\">21265<a name=\"example-referral-form-codes-21265\"> </a></td><td>Recent Hospitalization or ER Visit for this issue</td><td/></tr><tr><td style=\"white-space:nowrap\">21266<a name=\"example-referral-form-codes-21266\"> </a></td><td>&lt; 1 Year Old</td><td/></tr><tr><td style=\"white-space:nowrap\">21267<a name=\"example-referral-form-codes-21267\"> </a></td><td>Referral for child or youth (&lt;18 years old)</td><td/></tr><tr><td style=\"white-space:nowrap\">21268<a name=\"example-referral-form-codes-21268\"> </a></td><td>Preoperative Management</td><td/></tr><tr><td style=\"white-space:nowrap\">21269<a name=\"example-referral-form-codes-21269\"> </a></td><td>Cognitively impaired</td><td/></tr><tr><td style=\"white-space:nowrap\">21270<a name=\"example-referral-form-codes-21270\"> </a></td><td>Falls risk</td><td/></tr><tr><td style=\"white-space:nowrap\">21271<a name=\"example-referral-form-codes-21271\"> </a></td><td>Hearing impaired</td><td/></tr><tr><td style=\"white-space:nowrap\">21272<a name=\"example-referral-form-codes-21272\"> </a></td><td>Patient requires lift</td><td/></tr><tr><td style=\"white-space:nowrap\">21273<a name=\"example-referral-form-codes-21273\"> </a></td><td>Vision impaired</td><td/></tr><tr><td style=\"white-space:nowrap\">21274<a name=\"example-referral-form-codes-21274\"> </a></td><td>Wheelchair</td><td/></tr><tr><td style=\"white-space:nowrap\">21275<a name=\"example-referral-form-codes-21275\"> </a></td><td>Allied Health Professional</td><td/></tr><tr><td style=\"white-space:nowrap\">21276<a name=\"example-referral-form-codes-21276\"> </a></td><td>Family Physician</td><td>Médecin de famille</td></tr><tr><td style=\"white-space:nowrap\">21277<a name=\"example-referral-form-codes-21277\"> </a></td><td>Physician Assistant</td><td/></tr><tr><td style=\"white-space:nowrap\">21278<a name=\"example-referral-form-codes-21278\"> </a></td><td>Medical Student</td><td/></tr><tr><td style=\"white-space:nowrap\">21279<a name=\"example-referral-form-codes-21279\"> </a></td><td>Nurse</td><td/></tr><tr><td style=\"white-space:nowrap\">21280<a name=\"example-referral-form-codes-21280\"> </a></td><td>Nurse Practitioner</td><td/></tr><tr><td style=\"white-space:nowrap\">21281<a name=\"example-referral-form-codes-21281\"> </a></td><td>Resident</td><td/></tr><tr><td style=\"white-space:nowrap\">21282<a name=\"example-referral-form-codes-21282\"> </a></td><td>Specialist</td><td/></tr><tr><td style=\"white-space:nowrap\">21283<a name=\"example-referral-form-codes-21283\"> </a></td><td>No known kidney issues</td><td>Aucun problème rénal connu</td></tr><tr><td style=\"white-space:nowrap\">21284<a name=\"example-referral-form-codes-21284\"> </a></td><td>Yes, patient has impaired renal function or a history of renal transplant</td><td/></tr><tr><td style=\"white-space:nowrap\">21285<a name=\"example-referral-form-codes-21285\"> </a></td><td>eGFR result</td><td/></tr><tr><td style=\"white-space:nowrap\">21286<a name=\"example-referral-form-codes-21286\"> </a></td><td>Has diabetes</td><td/></tr><tr><td style=\"white-space:nowrap\">21287<a name=\"example-referral-form-codes-21287\"> </a></td><td>On dialysis</td><td/></tr><tr><td style=\"white-space:nowrap\">21288<a name=\"example-referral-form-codes-21288\"> </a></td><td>Known hypersensitivity to contrast agents</td><td/></tr><tr><td style=\"white-space:nowrap\">21289<a name=\"example-referral-form-codes-21289\"> </a></td><td>History of reaction before the year 2000</td><td/></tr><tr><td style=\"white-space:nowrap\">21291<a name=\"example-referral-form-codes-21291\"> </a></td><td>Estimated Date of Delivery</td><td/></tr><tr><td style=\"white-space:nowrap\">21292<a name=\"example-referral-form-codes-21292\"> </a></td><td>Last Menstrual Period</td><td/></tr><tr><td style=\"white-space:nowrap\">21293<a name=\"example-referral-form-codes-21293\"> </a></td><td>Currently breastfeeding</td><td>Allaite actuellement</td></tr><tr><td style=\"white-space:nowrap\">21294<a name=\"example-referral-form-codes-21294\"> </a></td><td>Claustrophobia</td><td/></tr><tr><td style=\"white-space:nowrap\">21295<a name=\"example-referral-form-codes-21295\"> </a></td><td>Require general anesthesia</td><td/></tr><tr><td style=\"white-space:nowrap\">21296<a name=\"example-referral-form-codes-21296\"> </a></td><td>Has metal fragments in eye(s)/body</td><td/></tr><tr><td style=\"white-space:nowrap\">21297<a name=\"example-referral-form-codes-21297\"> </a></td><td>Has active electronic implants (e.g. Cardiac Implantable Electronic Device, Neurostimulator, Cochlear Implant, Medication Pump, etc.) or retained parts (e.g. leads, etc.):</td><td/></tr><tr><td style=\"white-space:nowrap\">21298<a name=\"example-referral-form-codes-21298\"> </a></td><td>Has other metal containing devices (e.g. Aneurysm Clip, IUD, Tissue Expander, Shunt, Stent, Coil, Traction Device, Glucose Monitor, etc.), metal foreign bodies (Shrapnel, Bullets, Subdermal Piercings, Etc), or orthopedic device:</td><td/></tr><tr><td style=\"white-space:nowrap\">21299<a name=\"example-referral-form-codes-21299\"> </a></td><td>CIED</td><td/></tr><tr><td style=\"white-space:nowrap\">21300<a name=\"example-referral-form-codes-21300\"> </a></td><td>Neurostimulator</td><td/></tr><tr><td style=\"white-space:nowrap\">21301<a name=\"example-referral-form-codes-21301\"> </a></td><td>Cochlear Implant</td><td/></tr><tr><td style=\"white-space:nowrap\">21302<a name=\"example-referral-form-codes-21302\"> </a></td><td>Medication Pump</td><td/></tr><tr><td style=\"white-space:nowrap\">21303<a name=\"example-referral-form-codes-21303\"> </a></td><td>Aneurysm Clip</td><td/></tr><tr><td style=\"white-space:nowrap\">21304<a name=\"example-referral-form-codes-21304\"> </a></td><td>Coil</td><td/></tr><tr><td style=\"white-space:nowrap\">21305<a name=\"example-referral-form-codes-21305\"> </a></td><td>Glucose Monitor</td><td/></tr><tr><td style=\"white-space:nowrap\">21306<a name=\"example-referral-form-codes-21306\"> </a></td><td>Heart Valve</td><td/></tr><tr><td style=\"white-space:nowrap\">21307<a name=\"example-referral-form-codes-21307\"> </a></td><td>Copper or Stainless Steel IUD</td><td/></tr><tr><td style=\"white-space:nowrap\">21308<a name=\"example-referral-form-codes-21308\"> </a></td><td>Orthopedic Devices</td><td/></tr><tr><td style=\"white-space:nowrap\">21309<a name=\"example-referral-form-codes-21309\"> </a></td><td>Pessary</td><td/></tr><tr><td style=\"white-space:nowrap\">21310<a name=\"example-referral-form-codes-21310\"> </a></td><td>Prosthesis</td><td/></tr><tr><td style=\"white-space:nowrap\">21311<a name=\"example-referral-form-codes-21311\"> </a></td><td>Shunt</td><td/></tr><tr><td style=\"white-space:nowrap\">21312<a name=\"example-referral-form-codes-21312\"> </a></td><td>Stent</td><td/></tr><tr><td style=\"white-space:nowrap\">21313<a name=\"example-referral-form-codes-21313\"> </a></td><td>Subdermal Piercings</td><td/></tr><tr><td style=\"white-space:nowrap\">21314<a name=\"example-referral-form-codes-21314\"> </a></td><td>Tissue Expander</td><td/></tr><tr><td style=\"white-space:nowrap\">21315<a name=\"example-referral-form-codes-21315\"> </a></td><td>Traction Device</td><td/></tr><tr><td style=\"white-space:nowrap\">21316<a name=\"example-referral-form-codes-21316\"> </a></td><td>Patient has impaired renal function or a history of renal transplant</td><td/></tr><tr><td style=\"white-space:nowrap\">21317<a name=\"example-referral-form-codes-21317\"> </a></td><td>She/Her</td><td/></tr><tr><td style=\"white-space:nowrap\">21318<a name=\"example-referral-form-codes-21318\"> </a></td><td>He/Him</td><td/></tr><tr><td style=\"white-space:nowrap\">21319<a name=\"example-referral-form-codes-21319\"> </a></td><td>They/Them</td><td/></tr><tr><td style=\"white-space:nowrap\">21320<a name=\"example-referral-form-codes-21320\"> </a></td><td>Immunocompromised</td><td/></tr><tr><td style=\"white-space:nowrap\">21321<a name=\"example-referral-form-codes-21321\"> </a></td><td>Left</td><td/></tr><tr><td style=\"white-space:nowrap\">21322<a name=\"example-referral-form-codes-21322\"> </a></td><td>Right</td><td/></tr><tr><td style=\"white-space:nowrap\">21323<a name=\"example-referral-form-codes-21323\"> </a></td><td>Bilateral</td><td>Bilatéral</td></tr><tr><td style=\"white-space:nowrap\">21324<a name=\"example-referral-form-codes-21324\"> </a></td><td>Patient cannot provide reliable medical history or provide consent to contrast injections (where applicable)</td><td/></tr><tr><td style=\"white-space:nowrap\">21325<a name=\"example-referral-form-codes-21325\"> </a></td><td>Abnormal Lab Finding</td><td/></tr><tr><td style=\"white-space:nowrap\">21326<a name=\"example-referral-form-codes-21326\"> </a></td><td>Vomiting</td><td/></tr><tr><td style=\"white-space:nowrap\">21327<a name=\"example-referral-form-codes-21327\"> </a></td><td>Weight Loss</td><td/></tr><tr><td style=\"white-space:nowrap\">21328<a name=\"example-referral-form-codes-21328\"> </a></td><td>Eating Concerns</td><td/></tr><tr><td style=\"white-space:nowrap\">21329<a name=\"example-referral-form-codes-21329\"> </a></td><td>Custody Considerations</td><td/></tr><tr><td style=\"white-space:nowrap\">21330<a name=\"example-referral-form-codes-21330\"> </a></td><td>Child Welfare Agency Involvement (e.g., Children's Aid Society)</td><td/></tr><tr><td style=\"white-space:nowrap\">21331<a name=\"example-referral-form-codes-21331\"> </a></td><td>Suspected Malignancy</td><td/></tr><tr><td style=\"white-space:nowrap\">21332<a name=\"example-referral-form-codes-21332\"> </a></td><td>Confirmed Malignancy</td><td/></tr><tr><td style=\"white-space:nowrap\">21333<a name=\"example-referral-form-codes-21333\"> </a></td><td>Endocrine Conditions</td><td/></tr><tr><td style=\"white-space:nowrap\">21344<a name=\"example-referral-form-codes-21344\"> </a></td><td>Breast Inflammation / Abscess</td><td/></tr><tr><td style=\"white-space:nowrap\">21345<a name=\"example-referral-form-codes-21345\"> </a></td><td>Imaging Abnormality</td><td/></tr><tr><td style=\"white-space:nowrap\">21346<a name=\"example-referral-form-codes-21346\"> </a></td><td>Wound Management</td><td/></tr><tr><td style=\"white-space:nowrap\">21347<a name=\"example-referral-form-codes-21347\"> </a></td><td>G6PD Deficiency</td><td/></tr><tr><td style=\"white-space:nowrap\">21348<a name=\"example-referral-form-codes-21348\"> </a></td><td>PK Deficiency</td><td/></tr><tr><td style=\"white-space:nowrap\">21349<a name=\"example-referral-form-codes-21349\"> </a></td><td>HbSS</td><td/></tr><tr><td style=\"white-space:nowrap\">21350<a name=\"example-referral-form-codes-21350\"> </a></td><td>HbSC</td><td/></tr><tr><td style=\"white-space:nowrap\">21351<a name=\"example-referral-form-codes-21351\"> </a></td><td>HbS/�-thalassemia</td><td/></tr><tr><td style=\"white-space:nowrap\">21352<a name=\"example-referral-form-codes-21352\"> </a></td><td>Transfusion-Dependent Thalassemia</td><td/></tr><tr><td style=\"white-space:nowrap\">21353<a name=\"example-referral-form-codes-21353\"> </a></td><td>Non-Transfusion-Dependent Thalassemia</td><td/></tr><tr><td style=\"white-space:nowrap\">21354<a name=\"example-referral-form-codes-21354\"> </a></td><td>Movement Disorder</td><td/></tr><tr><td style=\"white-space:nowrap\">21355<a name=\"example-referral-form-codes-21355\"> </a></td><td>Unintentional Weight Change / Nutritional Concerns</td><td/></tr><tr><td style=\"white-space:nowrap\">21356<a name=\"example-referral-form-codes-21356\"> </a></td><td>Sleep Concerns</td><td/></tr><tr><td style=\"white-space:nowrap\">21357<a name=\"example-referral-form-codes-21357\"> </a></td><td>Arrived in Canada in past 3-6 months</td><td/></tr><tr><td style=\"white-space:nowrap\">21358<a name=\"example-referral-form-codes-21358\"> </a></td><td>Recent or Ongoing Complications</td><td/></tr><tr><td style=\"white-space:nowrap\">21359<a name=\"example-referral-form-codes-21359\"> </a></td><td>Referred from Sickle Cell Comprehensive Care Clinic</td><td/></tr><tr><td style=\"white-space:nowrap\">21360<a name=\"example-referral-form-codes-21360\"> </a></td><td>Requires ongoing Red Blood Cell transfusion support</td><td/></tr><tr><td style=\"white-space:nowrap\">21361<a name=\"example-referral-form-codes-21361\"> </a></td><td>Transfer of care</td><td/></tr><tr><td style=\"white-space:nowrap\">21362<a name=\"example-referral-form-codes-21362\"> </a></td><td>Non-Invasive Vascular Testing</td><td/></tr><tr><td style=\"white-space:nowrap\">21363<a name=\"example-referral-form-codes-21363\"> </a></td><td>Vascular Consultation</td><td/></tr><tr><td style=\"white-space:nowrap\">21364<a name=\"example-referral-form-codes-21364\"> </a></td><td>Nerve Root Impingement / Radiculopathy Present</td><td/></tr><tr><td style=\"white-space:nowrap\">21365<a name=\"example-referral-form-codes-21365\"> </a></td><td>Functional Neurosurgery - Surgical Assessment (Epilepsy, Movement, Pain)</td><td/></tr><tr><td style=\"white-space:nowrap\">21366<a name=\"example-referral-form-codes-21366\"> </a></td><td>Adrenals</td><td/></tr><tr><td style=\"white-space:nowrap\">21367<a name=\"example-referral-form-codes-21367\"> </a></td><td>Bone</td><td/></tr><tr><td style=\"white-space:nowrap\">21368<a name=\"example-referral-form-codes-21368\"> </a></td><td>Kidneys</td><td/></tr><tr><td style=\"white-space:nowrap\">21369<a name=\"example-referral-form-codes-21369\"> </a></td><td>Liver</td><td/></tr><tr><td style=\"white-space:nowrap\">21370<a name=\"example-referral-form-codes-21370\"> </a></td><td>Lung</td><td/></tr><tr><td style=\"white-space:nowrap\">21371<a name=\"example-referral-form-codes-21371\"> </a></td><td>Lymph nodes</td><td/></tr><tr><td style=\"white-space:nowrap\">21372<a name=\"example-referral-form-codes-21372\"> </a></td><td>Mediastinal mass</td><td/></tr><tr><td style=\"white-space:nowrap\">21373<a name=\"example-referral-form-codes-21373\"> </a></td><td>Pancreas</td><td/></tr><tr><td style=\"white-space:nowrap\">21374<a name=\"example-referral-form-codes-21374\"> </a></td><td>Pelvis</td><td/></tr><tr><td style=\"white-space:nowrap\">21375<a name=\"example-referral-form-codes-21375\"> </a></td><td>Thoracic Outlet Syndrome</td><td/></tr><tr><td style=\"white-space:nowrap\">21376<a name=\"example-referral-form-codes-21376\"> </a></td><td>Arterial</td><td/></tr><tr><td style=\"white-space:nowrap\">21377<a name=\"example-referral-form-codes-21377\"> </a></td><td>Venous</td><td/></tr><tr><td style=\"white-space:nowrap\">21378<a name=\"example-referral-form-codes-21378\"> </a></td><td>Arm</td><td/></tr><tr><td style=\"white-space:nowrap\">21379<a name=\"example-referral-form-codes-21379\"> </a></td><td>Leg</td><td/></tr><tr><td style=\"white-space:nowrap\">21380<a name=\"example-referral-form-codes-21380\"> </a></td><td>Ankle brachial index (screening)</td><td/></tr><tr><td style=\"white-space:nowrap\">21381<a name=\"example-referral-form-codes-21381\"> </a></td><td>Fasting</td><td/></tr><tr><td style=\"white-space:nowrap\">21382<a name=\"example-referral-form-codes-21382\"> </a></td><td>Post-prandial</td><td/></tr><tr><td style=\"white-space:nowrap\">21383<a name=\"example-referral-form-codes-21383\"> </a></td><td>Existing PICC line</td><td/></tr><tr><td style=\"white-space:nowrap\">21384<a name=\"example-referral-form-codes-21384\"> </a></td><td>Existing Port-a-Cath</td><td/></tr><tr><td style=\"white-space:nowrap\">21385<a name=\"example-referral-form-codes-21385\"> </a></td><td>What is the patient's current resting heart rate (bpm)?</td><td/></tr><tr><td style=\"white-space:nowrap\">21386<a name=\"example-referral-form-codes-21386\"> </a></td><td>Known contraindications to Nitroglycerin:</td><td/></tr><tr><td style=\"white-space:nowrap\">21387<a name=\"example-referral-form-codes-21387\"> </a></td><td>Is the patient currently on beta-blockers?</td><td/></tr><tr><td style=\"white-space:nowrap\">21388<a name=\"example-referral-form-codes-21388\"> </a></td><td>Severe/critical aortic stenosis</td><td/></tr><tr><td style=\"white-space:nowrap\">21389<a name=\"example-referral-form-codes-21389\"> </a></td><td>Severe symptomatic aortic insufficiency</td><td/></tr><tr><td style=\"white-space:nowrap\">21390<a name=\"example-referral-form-codes-21390\"> </a></td><td>Decompensated congestive heart failure</td><td/></tr><tr><td style=\"white-space:nowrap\">21391<a name=\"example-referral-form-codes-21391\"> </a></td><td>Allergy to Beta-blockers</td><td/></tr><tr><td style=\"white-space:nowrap\">21392<a name=\"example-referral-form-codes-21392\"> </a></td><td>Prior hospitalization for lung disease</td><td/></tr><tr><td style=\"white-space:nowrap\">21393<a name=\"example-referral-form-codes-21393\"> </a></td><td>Active bronchospasm</td><td/></tr><tr><td style=\"white-space:nowrap\">21394<a name=\"example-referral-form-codes-21394\"> </a></td><td>2nd or 3rd degree heart block, or 1st degree with PR&gt;0.42s</td><td/></tr><tr><td style=\"white-space:nowrap\">21395<a name=\"example-referral-form-codes-21395\"> </a></td><td>Will the patient be prescribed a beta-blocker?</td><td/></tr><tr><td style=\"white-space:nowrap\">21396<a name=\"example-referral-form-codes-21396\"> </a></td><td>Spinal Cord Compression Present</td><td/></tr><tr><td style=\"white-space:nowrap\">21397<a name=\"example-referral-form-codes-21397\"> </a></td><td>Date of First Suspicion of Cancer</td><td/></tr><tr><td style=\"white-space:nowrap\">21398<a name=\"example-referral-form-codes-21398\"> </a></td><td>Abdomen Pelvis Angiography</td><td/></tr><tr><td style=\"white-space:nowrap\">21399<a name=\"example-referral-form-codes-21399\"> </a></td><td>None of the above</td><td/></tr><tr><td style=\"white-space:nowrap\">21400<a name=\"example-referral-form-codes-21400\"> </a></td><td>Unsure/Unknown</td><td/></tr><tr><td style=\"white-space:nowrap\">21401<a name=\"example-referral-form-codes-21401\"> </a></td><td>Intersex</td><td/></tr><tr><td style=\"white-space:nowrap\">21402<a name=\"example-referral-form-codes-21402\"> </a></td><td>Other</td><td/></tr><tr><td style=\"white-space:nowrap\">21403<a name=\"example-referral-form-codes-21403\"> </a></td><td>Translator Required</td><td/></tr><tr><td style=\"white-space:nowrap\">21404<a name=\"example-referral-form-codes-21404\"> </a></td><td>Preferred Name</td><td/></tr><tr><td style=\"white-space:nowrap\">21405<a name=\"example-referral-form-codes-21405\"> </a></td><td>Voicemails acceptable</td><td/></tr><tr><td style=\"white-space:nowrap\">21406<a name=\"example-referral-form-codes-21406\"> </a></td><td>Alternate contact</td><td/></tr><tr><td style=\"white-space:nowrap\">21407<a name=\"example-referral-form-codes-21407\"> </a></td><td>Yes</td><td/></tr><tr><td style=\"white-space:nowrap\">21408<a name=\"example-referral-form-codes-21408\"> </a></td><td>No</td><td/></tr><tr><td style=\"white-space:nowrap\">21409<a name=\"example-referral-form-codes-21409\"> </a></td><td>Unsafe contact persons (do not speak with)</td><td/></tr><tr><td style=\"white-space:nowrap\">21410<a name=\"example-referral-form-codes-21410\"> </a></td><td>Only speak with patient directly</td><td/></tr><tr><td style=\"white-space:nowrap\">21411<a name=\"example-referral-form-codes-21411\"> </a></td><td>Accessibility concerns or disability</td><td/></tr><tr><td style=\"white-space:nowrap\">21412<a name=\"example-referral-form-codes-21412\"> </a></td><td>Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)</td><td/></tr><tr><td style=\"white-space:nowrap\">21413<a name=\"example-referral-form-codes-21413\"> </a></td><td>Send copies of reports to additional providers</td><td/></tr><tr><td style=\"white-space:nowrap\">21414<a name=\"example-referral-form-codes-21414\"> </a></td><td>This is the Primary Care Provider</td><td/></tr><tr><td style=\"white-space:nowrap\">21415<a name=\"example-referral-form-codes-21415\"> </a></td><td>CPP attached separately (if not entered below)</td><td/></tr><tr><td style=\"white-space:nowrap\">21416<a name=\"example-referral-form-codes-21416\"> </a></td><td>Preferred consultant or location</td><td/></tr><tr><td style=\"white-space:nowrap\">21417<a name=\"example-referral-form-codes-21417\"> </a></td><td>Patient willing to travel for shorter wait time</td><td/></tr><tr><td style=\"white-space:nowrap\">21418<a name=\"example-referral-form-codes-21418\"> </a></td><td>Personal Health Information that is medically relevant has not been disclosed at the request of the patient.</td><td/></tr><tr><td style=\"white-space:nowrap\">21419<a name=\"example-referral-form-codes-21419\"> </a></td><td>OHIP</td><td/></tr><tr><td style=\"white-space:nowrap\">21420<a name=\"example-referral-form-codes-21420\"> </a></td><td>WSIB Case</td><td/></tr><tr><td style=\"white-space:nowrap\">21421<a name=\"example-referral-form-codes-21421\"> </a></td><td>DND</td><td/></tr><tr><td style=\"white-space:nowrap\">21422<a name=\"example-referral-form-codes-21422\"> </a></td><td>IFH</td><td/></tr><tr><td style=\"white-space:nowrap\">21423<a name=\"example-referral-form-codes-21423\"> </a></td><td>RAMQ</td><td/></tr></table></div>"
  },
  "url": "http://ontariohealth.ca/fhir/eforms/CodeSystem/example-referral-form-codes",
  "version": "1.2.0",
  "name": "ExampleReferralFormCodes",
  "title": "Example Referral Form Codes",
  "status": "active",
  "experimental": true,
  "publisher": "Ontario Health",
  "description": "An example set of Ontario Health custom codes identifying standardized referral form (SRF) terms and/or concepts.  Not for use with 'real' forms.",
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "urn:iso:std:iso:3166",
          "code": "CA"
        }
      ]
    }
  ],
  "caseSensitive": true,
  "content": "complete",
  "count": 1288,
  "concept": [
    {
      "code": "20001",
      "display": "Cardiac Testing"
    },
    {
      "code": "20002",
      "display": "Cardiology Consultation"
    },
    {
      "code": "20003",
      "display": "24 Hour Ambulatory Blood Pressure Monitoring (Not OHIP Covered)"
    },
    {
      "code": "20004",
      "display": "Coronary Angiogram"
    },
    {
      "code": "20005",
      "display": "Echocardiogram - Resting"
    },
    {
      "code": "20006",
      "display": "Electrocardiogram (ECG)"
    },
    {
      "code": "20007",
      "display": "Holter Monitoring"
    },
    {
      "code": "20008",
      "display": "Loop / Event Monitor"
    },
    {
      "code": "20009",
      "display": "Stress Testing"
    },
    {
      "code": "20010",
      "display": "Nuclear Medicine"
    },
    {
      "code": "20011",
      "display": "Tilt Table Testing"
    },
    {
      "code": "20012",
      "display": "Echocardiogram (2D)"
    },
    {
      "code": "20013",
      "display": "Echocardiogram with Contrast"
    },
    {
      "code": "20014",
      "display": "Echocardiogram with Saline (Bubble)"
    },
    {
      "code": "20015",
      "display": "Pediatric Echocardiogram"
    },
    {
      "code": "20016",
      "display": "Transesophageal Echocardiogram (TEE)"
    },
    {
      "code": "20017",
      "display": "24 Hours"
    },
    {
      "code": "20018",
      "display": "48 Hours"
    },
    {
      "code": "20019",
      "display": "72 Hours"
    },
    {
      "code": "20020",
      "display": "7 Days"
    },
    {
      "code": "20021",
      "display": "14 Days"
    },
    {
      "code": "20022",
      "display": "ECG - Exercise Stress Test"
    },
    {
      "code": "20023",
      "display": "ECG - Dobutamine/Persantine Stress Test"
    },
    {
      "code": "20024",
      "display": "Echocardiogram - Exercise Stress Test"
    },
    {
      "code": "20025",
      "display": "Echocardiogram - Dobutamine/Persantine Stress Test"
    },
    {
      "code": "20026",
      "display": "MUGA - Resting"
    },
    {
      "code": "20027",
      "display": "Cardiac Pyrophosphate"
    },
    {
      "code": "20028",
      "display": "MIBI Scans / Myocardial Perfusion Imaging (MPI):"
    },
    {
      "code": "20029",
      "display": "MIBI Scan - Exercise Stress Test"
    },
    {
      "code": "20030",
      "display": "MIBI Scan - Dobutamine/Persantine Stress Test"
    },
    {
      "code": "20031",
      "display": "Thallium Viability Test"
    },
    {
      "code": "20032",
      "display": "Arrythmias or Palpitations"
    },
    {
      "code": "20033",
      "display": "Cardiovascular Risk Assessment"
    },
    {
      "code": "20034",
      "display": "Chest Pain or Angina"
    },
    {
      "code": "20035",
      "display": "Congenital Heart Disease"
    },
    {
      "code": "20036",
      "display": "Congestive Heart Failure"
    },
    {
      "code": "20037",
      "display": "Coronary Artery Disease"
    },
    {
      "code": "20038",
      "display": "Dyspnea"
    },
    {
      "code": "20039",
      "display": "Hypertension"
    },
    {
      "code": "20040",
      "display": "Murmur"
    },
    {
      "code": "20041",
      "display": "Pericardial Disease"
    },
    {
      "code": "20042",
      "display": "Peripheral Edema"
    },
    {
      "code": "20043",
      "display": "Post-Myocardial Infarction"
    },
    {
      "code": "20044",
      "display": "Pre-Operative Consultation"
    },
    {
      "code": "20045",
      "display": "Syncope"
    },
    {
      "code": "20046",
      "display": "Valvular Heart Disease or Prosthetic Heart Valve"
    },
    {
      "code": "20047",
      "display": "Acne or Rosacea"
    },
    {
      "code": "20048",
      "display": "Alopecia or Hair Loss"
    },
    {
      "code": "20049",
      "display": "Cosmetic"
    },
    {
      "code": "20050",
      "display": "Eczema or Dermatitis"
    },
    {
      "code": "20051",
      "display": "Hidradenitis Suppurativa"
    },
    {
      "code": "20052",
      "display": "Hives or Urticaria"
    },
    {
      "code": "20053",
      "display": "Nail Concerns"
    },
    {
      "code": "20054",
      "display": "Pruritus NYD"
    },
    {
      "code": "20055",
      "display": "Psoriasis"
    },
    {
      "code": "20056",
      "display": "Rash NYD"
    },
    {
      "code": "20057",
      "display": "Skin Cancer or Suspicious Lesion(s)"
    },
    {
      "code": "20058",
      "display": "Skin Check"
    },
    {
      "code": "20059",
      "display": "Skin Infection - Chronic"
    },
    {
      "code": "20060",
      "display": "Ulcer or Wounds"
    },
    {
      "code": "20061",
      "display": "Warts"
    },
    {
      "code": "20062",
      "display": "Vitiligo"
    },
    {
      "code": "20063",
      "display": "Actinic Keratoses"
    },
    {
      "code": "20064",
      "display": "Basal Cell Cancer"
    },
    {
      "code": "20065",
      "display": "Squamous Cell Cancer"
    },
    {
      "code": "20066",
      "display": "Melanoma"
    },
    {
      "code": "20067",
      "display": "Suspicious Lesion(s)"
    },
    {
      "code": "20068",
      "display": "Biopsy confirmed"
    },
    {
      "code": "20069",
      "display": "Abdominal Pain NYD or Bloating"
    },
    {
      "code": "20070",
      "display": "Barrett's Esophagus - Surveillance"
    },
    {
      "code": "20071",
      "display": "Bleeding"
    },
    {
      "code": "20072",
      "display": "Colonoscopy Request (Abnormal FIT, Screening, Surveillance)"
    },
    {
      "code": "20073",
      "display": "Bowel Changes (Constipation, Diarrhea)"
    },
    {
      "code": "20074",
      "display": "Dysphagia"
    },
    {
      "code": "20075",
      "display": "Gastroesophageal Reflux Disease (GERD)"
    },
    {
      "code": "20076",
      "display": "Irritable Bowel Syndrome"
    },
    {
      "code": "20077",
      "display": "Inflammatory Bowel Disease (IBD)"
    },
    {
      "code": "20078",
      "display": "Iron Deficiency Anemia - Unexplained"
    },
    {
      "code": "20079",
      "display": "Liver Disease"
    },
    {
      "code": "20080",
      "display": "Nausea or Vomiting NYD"
    },
    {
      "code": "20081",
      "display": "Pancreatic Disease"
    },
    {
      "code": "20082",
      "display": "Weight Loss - Unexplained"
    },
    {
      "code": "20083",
      "display": "Lower GI or Rectal"
    },
    {
      "code": "20084",
      "display": "Upper GI"
    },
    {
      "code": "20085",
      "display": "Constipation"
    },
    {
      "code": "20086",
      "display": "Diarrhea"
    },
    {
      "code": "20087",
      "display": "Abnormal FIT"
    },
    {
      "code": "20088",
      "display": "Average Risk"
    },
    {
      "code": "20089",
      "display": "First-Degree Relative with Colorectal Cancer"
    },
    {
      "code": "20090",
      "display": "Other Family History"
    },
    {
      "code": "20091",
      "display": "Prior History of Colorectal Polyps"
    },
    {
      "code": "20092",
      "display": "Prior History of Colorectal Cancer"
    },
    {
      "code": "20093",
      "display": "Surveillance in IBD Colitis of at least 8 years duration"
    },
    {
      "code": "20094",
      "display": "Crohn's disease"
    },
    {
      "code": "20095",
      "display": "Ulcerative colitis"
    },
    {
      "code": "20096",
      "display": "Alcohol Associated Liver Disease"
    },
    {
      "code": "20097",
      "display": "Cirrhosis"
    },
    {
      "code": "20098",
      "display": "Hepatitis B"
    },
    {
      "code": "20099",
      "display": "Hepatitis C"
    },
    {
      "code": "20100",
      "display": "Liver Function Tests - Abnormal"
    },
    {
      "code": "20101",
      "display": "Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) / Fatty Liver"
    },
    {
      "code": "20102",
      "display": "Abnormal Imaging of Pancreas"
    },
    {
      "code": "20103",
      "display": "Pancreatitis"
    },
    {
      "code": "20104",
      "display": "Ear and Hearing"
    },
    {
      "code": "20105",
      "display": "Facial Plastics & Reconstruction"
    },
    {
      "code": "20106",
      "display": "Head, Neck and Thyroid (Malignancy, Masses, Nodules, or Cysts)"
    },
    {
      "code": "20107",
      "display": "Nose and Sinus"
    },
    {
      "code": "20108",
      "display": "Throat and Oral Cavity"
    },
    {
      "code": "20109",
      "display": "Cerumen Impaction"
    },
    {
      "code": "20110",
      "display": "Eustachian Tube Dysfunction"
    },
    {
      "code": "20111",
      "display": "Hearing Loss - Sudden / Unilateral"
    },
    {
      "code": "20112",
      "display": "Otitis Externa"
    },
    {
      "code": "20113",
      "display": "Otitis Media"
    },
    {
      "code": "20114",
      "display": "Tinnitus"
    },
    {
      "code": "20115",
      "display": "Vertigo or Dizziness"
    },
    {
      "code": "20116",
      "display": "Nasopharyngeal Lesions"
    },
    {
      "code": "20117",
      "display": "Oropharyngeal Lesions"
    },
    {
      "code": "20118",
      "display": "Parathyroid Cyst, Nodule, or Mass"
    },
    {
      "code": "20119",
      "display": "Salivary Gland Mass"
    },
    {
      "code": "20120",
      "display": "Skin Cancer"
    },
    {
      "code": "20121",
      "display": "Thyroid Cyst, Nodule, or Mass"
    },
    {
      "code": "20122",
      "display": "Anosmia or Hyposmia"
    },
    {
      "code": "20123",
      "display": "Deviated Nasal Septum"
    },
    {
      "code": "20124",
      "display": "Epistaxis"
    },
    {
      "code": "20125",
      "display": "Foreign Body Removal"
    },
    {
      "code": "20126",
      "display": "Nasal Polyps"
    },
    {
      "code": "20127",
      "display": "Rhinitis or Sinusitis - Chronic"
    },
    {
      "code": "20128",
      "display": "Cough or Throat Clearing - Chronic"
    },
    {
      "code": "20130",
      "display": "Dysphonia / Hoarse voice"
    },
    {
      "code": "20131",
      "display": "Globus Sensation"
    },
    {
      "code": "20132",
      "display": "Lymphadenopathy"
    },
    {
      "code": "20133",
      "display": "Odynophagia"
    },
    {
      "code": "20134",
      "display": "Salivary Gland Stones"
    },
    {
      "code": "20135",
      "display": "Sleep-Related Breathing Disorders (e.g. OSA)"
    },
    {
      "code": "20136",
      "display": "Speech and Language Delay"
    },
    {
      "code": "20137",
      "display": "Tongue Tie"
    },
    {
      "code": "20138",
      "display": "Tonsillar or Adenoid Disorders"
    },
    {
      "code": "20139",
      "display": "Respiratory Testing"
    },
    {
      "code": "20140",
      "display": "Respirology Consultation"
    },
    {
      "code": "20141",
      "display": "Spirometry (Include post-bronchodilator, if indicated)"
    },
    {
      "code": "20142",
      "display": "Full Pulmonary Function Testing (Include post-bronchodilator, if indicated)"
    },
    {
      "code": "20143",
      "display": "Asthma"
    },
    {
      "code": "20144",
      "display": "Cough NYD"
    },
    {
      "code": "20145",
      "display": "Chronic Obstructive Pulmonary Disease (COPD)"
    },
    {
      "code": "20146",
      "display": "Dyspnea NYD"
    },
    {
      "code": "20147",
      "display": "Interstitial Lung Disease"
    },
    {
      "code": "20148",
      "display": "Adrenal Mass"
    },
    {
      "code": "20149",
      "display": "Benign Prostatic Hyperplasia (BPH) / Lower Urinary Tract Symptoms (LUTS)"
    },
    {
      "code": "20150",
      "display": "Bladder Mass"
    },
    {
      "code": "20151",
      "display": "Elevated Prostate-Specific Antigen (PSA) or Suspicious Digital Rectal Exam (DRE)"
    },
    {
      "code": "20152",
      "display": "Erectile Dysfunction"
    },
    {
      "code": "20153",
      "display": "Hematuria"
    },
    {
      "code": "20154",
      "display": "Hydrocele, Varicocele or Spermatocele"
    },
    {
      "code": "20155",
      "display": "Hydronephrosis"
    },
    {
      "code": "20156",
      "display": "Hypogonadism"
    },
    {
      "code": "20157",
      "display": "Infertility - Male"
    },
    {
      "code": "20158",
      "display": "Penile Lesion"
    },
    {
      "code": "20159",
      "display": "Peyronie's Disease"
    },
    {
      "code": "20160",
      "display": "Phimosis, Foreskin Issue or Balanitis"
    },
    {
      "code": "20161",
      "display": "Renal Mass or Cyst"
    },
    {
      "code": "20162",
      "display": "Nephrolithiasis / Renal Colic"
    },
    {
      "code": "20163",
      "display": "Testicular Mass"
    },
    {
      "code": "20164",
      "display": "Urinary Incontinence or Overactive Bladder"
    },
    {
      "code": "20165",
      "display": "Urinary Tract Infections - Recurrent"
    },
    {
      "code": "20166",
      "display": "Vasectomy"
    },
    {
      "code": "20167",
      "display": "Gross"
    },
    {
      "code": "20168",
      "display": "Microscopic"
    },
    {
      "code": "20169",
      "display": "Imaging demonstrates an obstructive stone"
    },
    {
      "code": "20170",
      "display": "Neurodiagnostic Testing - Triage to Consult if Appropriate"
    },
    {
      "code": "20171",
      "display": "Neurodiagnostic Testing Only (EEG, EMG/NCS)"
    },
    {
      "code": "20172",
      "display": "Neurology Consultation"
    },
    {
      "code": "20173",
      "display": "Electroencephalography (EEG)"
    },
    {
      "code": "20174",
      "display": "Electromyography (EMG) / Nerve Conduction Study (NCS)"
    },
    {
      "code": "20175",
      "display": "Routine EEG"
    },
    {
      "code": "20176",
      "display": "Sleep Deprived EEG"
    },
    {
      "code": "20177",
      "display": "Carpal Tunnel Syndrome"
    },
    {
      "code": "20178",
      "display": "Cervical Radiculopathy"
    },
    {
      "code": "20179",
      "display": "Lumbar Radiculopathy"
    },
    {
      "code": "20180",
      "display": "Peripheral Neuropathy / Polyneuropathy"
    },
    {
      "code": "20181",
      "display": "Balance, Dizziness, or Vertigo"
    },
    {
      "code": "20182",
      "display": "Concussion or Traumatic Brain Injury (TBI)"
    },
    {
      "code": "20183",
      "display": "Epilepsy or Seizure"
    },
    {
      "code": "20184",
      "display": "Headache or Migraines"
    },
    {
      "code": "20185",
      "display": "Movement Disorders (including Parkinson's and Tremors)"
    },
    {
      "code": "20186",
      "display": "Multiple Sclerosis or Demyelinating Disease"
    },
    {
      "code": "20187",
      "display": "Neurocognitive Disorder"
    },
    {
      "code": "20188",
      "display": "Neuropathy or Weakness"
    },
    {
      "code": "20190",
      "display": "Stroke or TIA"
    },
    {
      "code": "20191",
      "display": "Crystal Arthropathies (Gout, Pseudogout)"
    },
    {
      "code": "20192",
      "display": "Connective Tissue Diseases (Lupus, Sjogren's, Scleroderma, Inflammatory Myositis)"
    },
    {
      "code": "20193",
      "display": "Corticosteroid Injections (Osteoarthritis / Tendinitis / Bursitis / Joint Injections)"
    },
    {
      "code": "20194",
      "display": "Giant Cell Arteritis"
    },
    {
      "code": "20195",
      "display": "Inflammatory Arthritis (e.g. Rheumatoid Arthritis)"
    },
    {
      "code": "20196",
      "display": "Polymyalgia Rheumatica"
    },
    {
      "code": "20197",
      "display": "Psoriatic Arthritis"
    },
    {
      "code": "20198",
      "display": "Spondyloarthritis"
    },
    {
      "code": "20199",
      "display": "Vasculitis"
    },
    {
      "code": "20200",
      "display": "= 3 attacks in the last year"
    },
    {
      "code": "20201",
      "display": "Alopecia / sicca / oral ulcers"
    },
    {
      "code": "20202",
      "display": "Arterial / venous thrombosis"
    },
    {
      "code": "20203",
      "display": "Glomerulonephritis"
    },
    {
      "code": "20204",
      "display": "Hemolytic anemia / ITP"
    },
    {
      "code": "20205",
      "display": "Inflammatory Arthritis"
    },
    {
      "code": "20207",
      "display": "Objective proximal muscle weakness and high CK"
    },
    {
      "code": "20208",
      "display": "Pericarditis / pleural effusions"
    },
    {
      "code": "20209",
      "display": "Photosensitivity and rash"
    },
    {
      "code": "20210",
      "display": "Pregnancy loss (recurrent)"
    },
    {
      "code": "20211",
      "display": "Raynaud�s phenomenon"
    },
    {
      "code": "20212",
      "display": "Sclerodactyly / puffy fingers"
    },
    {
      "code": "20213",
      "display": "Referred for temporal artery biopsy or ultrasound"
    },
    {
      "code": "20214",
      "display": "Vision loss or diplopia"
    },
    {
      "code": "20215",
      "display": "New headache"
    },
    {
      "code": "20216",
      "display": "Jaw claudication"
    },
    {
      "code": "20217",
      "display": "Scalp tenderness"
    },
    {
      "code": "20218",
      "display": "Significant weight loss or malaise"
    },
    {
      "code": "20219",
      "display": "Unexplained dry cough"
    },
    {
      "code": "20220",
      "display": "Ankylosing Spondylitis"
    },
    {
      "code": "20221",
      "display": "Reactive Arthritis"
    },
    {
      "code": "20222",
      "display": "IBD Related Arthritis"
    },
    {
      "code": "20223",
      "display": "Contraception"
    },
    {
      "code": "20224",
      "display": "Fertility and Infertility"
    },
    {
      "code": "20225",
      "display": "Gynecology"
    },
    {
      "code": "20226",
      "display": "Obstetrics (Routine)"
    },
    {
      "code": "20227",
      "display": "Obstetrics (High Risk)"
    },
    {
      "code": "20228",
      "display": "Pregnancy Termination"
    },
    {
      "code": "20229",
      "display": "Transgender Care"
    },
    {
      "code": "20230",
      "display": "Contraceptive Counselling"
    },
    {
      "code": "20231",
      "display": "IUD Insertion"
    },
    {
      "code": "20232",
      "display": "IUD Removal"
    },
    {
      "code": "20233",
      "display": "Contraceptive Implant Insertion"
    },
    {
      "code": "20234",
      "display": "Contraceptive Implant Removal"
    },
    {
      "code": "20235",
      "display": "Fertility Status Evaluation"
    },
    {
      "code": "20236",
      "display": "Recurrent Pregnancy Loss"
    },
    {
      "code": "20237",
      "display": "Abnormal Cervical Cancer Screening"
    },
    {
      "code": "20238",
      "display": "Abnormal Uterine Bleeding"
    },
    {
      "code": "20239",
      "display": "Adnexal Mass or Cyst"
    },
    {
      "code": "20240",
      "display": "Amenorrhea"
    },
    {
      "code": "20241",
      "display": "Dyspareunia or Vaginismus"
    },
    {
      "code": "20242",
      "display": "Early Pregnancy Loss or Complication"
    },
    {
      "code": "20243",
      "display": "Endometriosis or Pelvic Pain"
    },
    {
      "code": "20244",
      "display": "Menopause Management (including Hormone Replacement Therapy)"
    },
    {
      "code": "20245",
      "display": "Pelvic Inflammatory Disease"
    },
    {
      "code": "20246",
      "display": "Polycystic Ovarian Syndrome (PCOS)"
    },
    {
      "code": "20247",
      "display": "Post-Menopausal Bleeding"
    },
    {
      "code": "20248",
      "display": "Pelvic Organ Prolapse or Pessary Management"
    },
    {
      "code": "20249",
      "display": "Urinary Incontinence"
    },
    {
      "code": "20250",
      "display": "Uterine Fibroids, Polyps, Septum, or Other Structural Abnormalities"
    },
    {
      "code": "20251",
      "display": "Vaginitis"
    },
    {
      "code": "20252",
      "display": "Vulvar, Vaginal, or Cervical Disorders"
    },
    {
      "code": "20253",
      "display": "Total Antenatal Care"
    },
    {
      "code": "20254",
      "display": "Shared Antenatal Care"
    },
    {
      "code": "20255",
      "display": "Obstetrical Consult"
    },
    {
      "code": "20256",
      "display": "Last Menstrual Period (LMP)"
    },
    {
      "code": "20257",
      "display": "Estimated Date of Delivery (EDD)"
    },
    {
      "code": "20258",
      "display": "GTPAL"
    },
    {
      "code": "20259",
      "display": "Abnormal Prenatal Screen"
    },
    {
      "code": "20260",
      "display": "Congenital Abnormalities"
    },
    {
      "code": "20261",
      "display": "Diabetes (pre-existing)"
    },
    {
      "code": "20262",
      "display": "Gestational Diabetes"
    },
    {
      "code": "20263",
      "display": "HIV Pregnancy"
    },
    {
      "code": "20265",
      "display": "Infectious Disease"
    },
    {
      "code": "20266",
      "display": "Intrauterine Growth Restriction"
    },
    {
      "code": "20267",
      "display": "Medical Disease in Pregnancy"
    },
    {
      "code": "20268",
      "display": "Multiple Gestation (Twins, Triplets, Higher Order)"
    },
    {
      "code": "20269",
      "display": "Placental Abnormalities"
    },
    {
      "code": "20270",
      "display": "Pre-Conception Counselling"
    },
    {
      "code": "20271",
      "display": "Substance Abuse in Pregnancy"
    },
    {
      "code": "20272",
      "display": "Current gestational age"
    },
    {
      "code": "20273",
      "display": "Bicytopenia or Pancytopenia (decreases in more than one cell line)"
    },
    {
      "code": "20274",
      "display": "Bleeding or Abnormal INR/PTT"
    },
    {
      "code": "20275",
      "display": "Confirmed Malignant Hematology Consultation (biopsy proven)"
    },
    {
      "code": "20276",
      "display": "Red Blood Cells or Iron"
    },
    {
      "code": "20277",
      "display": "Myeloma or Paraproteinemia (e.g. Bence Jones proteinuria, monoclonal gammopathy)"
    },
    {
      "code": "20278",
      "display": "Lymph Nodes or Spleen"
    },
    {
      "code": "20279",
      "display": "Platelets"
    },
    {
      "code": "20280",
      "display": "Thrombosis"
    },
    {
      "code": "20281",
      "display": "Transfusion"
    },
    {
      "code": "20282",
      "display": "White Blood Cells"
    },
    {
      "code": "20283",
      "display": "Other Benign Hematology Consultation"
    },
    {
      "code": "20284",
      "display": "Other Malignant Hematology Consultation"
    },
    {
      "code": "20285",
      "display": "Labs abnormal - no bleeding / bruising"
    },
    {
      "code": "20286",
      "display": "Abnormal bleeding / bruising"
    },
    {
      "code": "20287",
      "display": "Anemia NYD"
    },
    {
      "code": "20288",
      "display": "Anemia - Iron Deficiency"
    },
    {
      "code": "20289",
      "display": "Erythrocytosis"
    },
    {
      "code": "20290",
      "display": "Ferritin - High"
    },
    {
      "code": "20291",
      "display": "Hemoglobinopathy"
    },
    {
      "code": "20292",
      "display": "Sickle Cell Disease"
    },
    {
      "code": "20293",
      "display": "Thallasemias"
    },
    {
      "code": "20294",
      "display": "Other Hemoglobinopathy"
    },
    {
      "code": "20295",
      "display": "Lymphadenopathy - Concern for Lymphoma"
    },
    {
      "code": "20296",
      "display": "Lymphoma"
    },
    {
      "code": "20297",
      "display": "Splenomegaly"
    },
    {
      "code": "20298",
      "display": "Thrombocytopenia (low platelets)"
    },
    {
      "code": "20299",
      "display": "Thrombocytosis (high platelets)"
    },
    {
      "code": "20300",
      "display": "Atrial Fibrillation Anticoagulation"
    },
    {
      "code": "20301",
      "display": "Mechanical Valve Anticoagulation"
    },
    {
      "code": "20302",
      "display": "Peripartum Thrombosis - Prevention or Treatment"
    },
    {
      "code": "20303",
      "display": "Peri-procedure Anticoagulation Management"
    },
    {
      "code": "20304",
      "display": "Superficial Vein Thrombosis"
    },
    {
      "code": "20305",
      "display": "Thrombophilia"
    },
    {
      "code": "20306",
      "display": "Venous Thromboembolism - Acute - Imaging Confirmed (e.g. DVT, PE)"
    },
    {
      "code": "20307",
      "display": "Venous Thromboembolism - Chronic (e.g. DVT, PE)"
    },
    {
      "code": "20308",
      "display": "Other Thrombosis Consultation"
    },
    {
      "code": "20309",
      "display": "Acute Leukemia (myeloid or lymphoblastic)"
    },
    {
      "code": "20310",
      "display": "Chronic Leukemia (myeloid or lymphoblastic)"
    },
    {
      "code": "20311",
      "display": "Leukocytosis (high white blood cells)"
    },
    {
      "code": "20312",
      "display": "Leukopenia (low white blood cells, including low neutrophil count)"
    },
    {
      "code": "20313",
      "display": "Acute Kidney Injury (AKI)"
    },
    {
      "code": "20314",
      "display": "Chronic Kidney Disease (CKD)"
    },
    {
      "code": "20315",
      "display": "Electrolyte Disorders"
    },
    {
      "code": "20318",
      "display": "Imaging Abnormalities"
    },
    {
      "code": "20319",
      "display": "Kidney Stones"
    },
    {
      "code": "20320",
      "display": "Proteinuria"
    },
    {
      "code": "20321",
      "display": "Suspected Glomerulonephritis/Renal Vasculitis"
    },
    {
      "code": "20322",
      "display": "Rapidly worsening kidney function, confirmed on repeat testing in absence of remediable causes"
    },
    {
      "code": "20323",
      "display": "ACR = 60 � Persistent for = 3 months"
    },
    {
      "code": "20324",
      "display": "eGFR < 30 � Persistent for = 3 months"
    },
    {
      "code": "20325",
      "display": "eGFR < 45 and confirmed decline of = 5 within 6 months"
    },
    {
      "code": "20326",
      "display": "eGFR < 45 and age = 50 without CKD risk factors"
    },
    {
      "code": "20327",
      "display": "5-year KFRE = 5%"
    },
    {
      "code": "20328",
      "display": "Gross (suggest Urology referral first for those > 40 years of age)"
    },
    {
      "code": "20329",
      "display": "Microscopic > 10 RBC/hpf - confirmed by microscopy"
    },
    {
      "code": "20330",
      "display": "Resistant"
    },
    {
      "code": "20331",
      "display": "Suspected Secondary Hypertension"
    },
    {
      "code": "20332",
      "display": "Multicystic / Polycystic kidneys"
    },
    {
      "code": "20333",
      "display": "Shrunken / Atrophic kidney"
    },
    {
      "code": "20334",
      "display": "Metabolic work-up for recurrent stones"
    },
    {
      "code": "20335",
      "display": "ACR = 30 without Diabetes Mellitus � Persistent for = 3 months"
    },
    {
      "code": "20336",
      "display": "24-hour urine protein = 1 g"
    },
    {
      "code": "20337",
      "display": "Hematuria with = 10 RBC/hpf � Confirmed by microscopy"
    },
    {
      "code": "20338",
      "display": "Urine ACR"
    },
    {
      "code": "20339",
      "display": "eGFR"
    },
    {
      "code": "20340",
      "display": "Potassium"
    },
    {
      "code": "20341",
      "display": "Shoulder"
    },
    {
      "code": "20342",
      "display": "Arm"
    },
    {
      "code": "20343",
      "display": "Elbow"
    },
    {
      "code": "20344",
      "display": "Forearm"
    },
    {
      "code": "20345",
      "display": "Wrist"
    },
    {
      "code": "20346",
      "display": "Hand"
    },
    {
      "code": "20347",
      "display": "Spine"
    },
    {
      "code": "20348",
      "display": "Pelvis"
    },
    {
      "code": "20349",
      "display": "Hip"
    },
    {
      "code": "20350",
      "display": "Thigh"
    },
    {
      "code": "20351",
      "display": "Knee"
    },
    {
      "code": "20352",
      "display": "Leg"
    },
    {
      "code": "20353",
      "display": "Ankle / Hindfoot"
    },
    {
      "code": "20354",
      "display": "Midfoot / Forefoot"
    },
    {
      "code": "20355",
      "display": "Fracture"
    },
    {
      "code": "20356",
      "display": "Joint Instability / Subluxation"
    },
    {
      "code": "20357",
      "display": "Osteoarthritis"
    },
    {
      "code": "20358",
      "display": "Pain NYD"
    },
    {
      "code": "20359",
      "display": "Rotator Cuff / Impingement"
    },
    {
      "code": "20360",
      "display": "Post-traumatic arthritis"
    },
    {
      "code": "20362",
      "display": "De Quervain�s Tenosynovitis"
    },
    {
      "code": "20363",
      "display": "Ganglion Cyst"
    },
    {
      "code": "20364",
      "display": "Dupuytren�s Contracture"
    },
    {
      "code": "20365",
      "display": "Finger Deformity"
    },
    {
      "code": "20366",
      "display": "Flexor Tendon Injury"
    },
    {
      "code": "20367",
      "display": "Trigger Finger"
    },
    {
      "code": "20368",
      "display": "Cervical Spine"
    },
    {
      "code": "20369",
      "display": "Thoracic Spine"
    },
    {
      "code": "20370",
      "display": "Lumbar Spine"
    },
    {
      "code": "20371",
      "display": "Deformity / Scoliosis / Kyphosis"
    },
    {
      "code": "20372",
      "display": "Myelopathy"
    },
    {
      "code": "20373",
      "display": "Neurogenic Claudication"
    },
    {
      "code": "20374",
      "display": "Spondylolisthesis"
    },
    {
      "code": "20375",
      "display": "Stenosis"
    },
    {
      "code": "20377",
      "display": "ACL Tear"
    },
    {
      "code": "20378",
      "display": "Cartilage Injury"
    },
    {
      "code": "20376",
      "display": "Knee Malalignment"
    },
    {
      "code": "20379",
      "display": "Loose Bodies"
    },
    {
      "code": "20380",
      "display": "Meniscal Tear"
    },
    {
      "code": "20381",
      "display": "Multi-Ligament Injury"
    },
    {
      "code": "20382",
      "display": "Achilles Tendinopathy"
    },
    {
      "code": "20383",
      "display": "Joint Instability"
    },
    {
      "code": "20384",
      "display": "Bunion"
    },
    {
      "code": "20385",
      "display": "Charcot Foot"
    },
    {
      "code": "20386",
      "display": "Flatfoot / Pes Planus"
    },
    {
      "code": "20387",
      "display": "Metatarsalgia"
    },
    {
      "code": "20388",
      "display": "Plantar Fasciitis"
    },
    {
      "code": "20389",
      "display": "Toe Deformity"
    },
    {
      "code": "20390",
      "display": "CT Requisition",
      "designation": [
        {
          "language": "fr",
          "value": "Demande de TDM"
        }
      ]
    },
    {
      "code": "20391",
      "display": "MRI Requisition",
      "designation": [
        {
          "language": "fr",
          "value": "Demande d'IRM"
        }
      ]
    },
    {
      "code": "20392",
      "display": "X-Ray Requisition",
      "designation": [
        {
          "language": "fr",
          "value": "Demande de radiographie"
        }
      ]
    },
    {
      "code": "20393",
      "display": "Ultrasound Requisition",
      "designation": [
        {
          "language": "fr",
          "value": "Demande d'échographie"
        }
      ]
    },
    {
      "code": "20394",
      "display": "Bone Mineral Density Requisition",
      "designation": [
        {
          "language": "fr",
          "value": "Demande de densitométrie osseuse"
        }
      ]
    },
    {
      "code": "20395",
      "display": "Head",
      "designation": [
        {
          "language": "fr",
          "value": "Tête"
        }
      ]
    },
    {
      "code": "20396",
      "display": "Neck",
      "designation": [
        {
          "language": "fr",
          "value": "Cou"
        }
      ]
    },
    {
      "code": "20397",
      "display": "Spine",
      "designation": [
        {
          "language": "fr",
          "value": "Colonne vertébrale"
        }
      ]
    },
    {
      "code": "20398",
      "display": "Thorax",
      "designation": [
        {
          "language": "fr",
          "value": "Thorax"
        }
      ]
    },
    {
      "code": "20399",
      "display": "Abdomen Pelvis",
      "designation": [
        {
          "language": "fr",
          "value": "Abdomen Bassin"
        }
      ]
    },
    {
      "code": "20400",
      "display": "Musculoskeletal",
      "designation": [
        {
          "language": "fr",
          "value": "Musculosquelettique"
        }
      ]
    },
    {
      "code": "20401",
      "display": "Angiography",
      "designation": [
        {
          "language": "fr",
          "value": "Angiographie"
        }
      ]
    },
    {
      "code": "20403",
      "display": "Whole-Body Low-Dose (Myeloma)",
      "designation": [
        {
          "language": "fr",
          "value": "Corps entier faible dose (Myélome)"
        }
      ]
    },
    {
      "code": "20404",
      "display": "Cardiac",
      "designation": [
        {
          "language": "fr",
          "value": "Cardiaque"
        }
      ]
    },
    {
      "code": "20405",
      "display": "Biopsy",
      "designation": [
        {
          "language": "fr",
          "value": "Biopsie"
        }
      ]
    },
    {
      "code": "20406",
      "display": "Brain",
      "designation": [
        {
          "language": "fr",
          "value": "Cerveau"
        }
      ]
    },
    {
      "code": "20408",
      "display": "Facial bones",
      "designation": [
        {
          "language": "fr",
          "value": "Os du visage"
        }
      ]
    },
    {
      "code": "20409",
      "display": "Internal auditory canals",
      "designation": [
        {
          "language": "fr",
          "value": "Canaux auditifs internes"
        }
      ]
    },
    {
      "code": "20410",
      "display": "Orbits",
      "designation": [
        {
          "language": "fr",
          "value": "Orbites"
        }
      ]
    },
    {
      "code": "20411",
      "display": "Sinuses",
      "designation": [
        {
          "language": "fr",
          "value": "Sinus"
        }
      ]
    },
    {
      "code": "20412",
      "display": "Temporal bones",
      "designation": [
        {
          "language": "fr",
          "value": "Os temporaux"
        }
      ]
    },
    {
      "code": "20414",
      "display": "Soft Tissue Neck",
      "designation": [
        {
          "language": "fr",
          "value": "Tissus mous du cou"
        }
      ]
    },
    {
      "code": "20415",
      "display": "Cervical Spine",
      "designation": [
        {
          "language": "fr",
          "value": "Colonne cervicale"
        }
      ]
    },
    {
      "code": "20416",
      "display": "Thoracic Spine",
      "designation": [
        {
          "language": "fr",
          "value": "Colonne thoracique"
        }
      ]
    },
    {
      "code": "20417",
      "display": "Lumbar Spine",
      "designation": [
        {
          "language": "fr",
          "value": "Colonne lombaire"
        }
      ]
    },
    {
      "code": "20418",
      "display": "Sacrum/Coccyx",
      "designation": [
        {
          "language": "fr",
          "value": "Sacrum/Coccyx"
        }
      ]
    },
    {
      "code": "20419",
      "display": "Sacroiliac Joints",
      "designation": [
        {
          "language": "fr",
          "value": "Articulations sacro-iliaques"
        }
      ]
    },
    {
      "code": "20420",
      "display": "Chest",
      "designation": [
        {
          "language": "fr",
          "value": "Thorax"
        }
      ]
    },
    {
      "code": "20421",
      "display": "Chest High Resolution",
      "designation": [
        {
          "language": "fr",
          "value": "Thorax haute résolution"
        }
      ]
    },
    {
      "code": "20422",
      "display": "Chest Low-Dose",
      "designation": [
        {
          "language": "fr",
          "value": "Thorax faible dose"
        }
      ]
    },
    {
      "code": "20423",
      "display": "Pulmonary Embolism",
      "designation": [
        {
          "language": "fr",
          "value": "Embolie pulmonaire"
        }
      ]
    },
    {
      "code": "20425",
      "display": "Thoracic Outlet",
      "designation": [
        {
          "language": "fr",
          "value": "Défilé thoracique"
        }
      ]
    },
    {
      "code": "20426",
      "display": "Chest Abdomen Pelvis",
      "designation": [
        {
          "language": "fr",
          "value": "Thorax Abdomen Bassin"
        }
      ]
    },
    {
      "code": "20427",
      "display": "Abdomen only",
      "designation": [
        {
          "language": "fr",
          "value": "Abdomen seulement"
        }
      ]
    },
    {
      "code": "20428",
      "display": "Pelvis only",
      "designation": [
        {
          "language": "fr",
          "value": "Bassin seulement"
        }
      ]
    },
    {
      "code": "20430",
      "display": "Colonography",
      "designation": [
        {
          "language": "fr",
          "value": "Colonographie"
        }
      ]
    },
    {
      "code": "20431",
      "display": "Enterography",
      "designation": [
        {
          "language": "fr",
          "value": "Entérographie"
        }
      ]
    },
    {
      "code": "20432",
      "display": "Renal Colic",
      "designation": [
        {
          "language": "fr",
          "value": "Colique rénale"
        }
      ]
    },
    {
      "code": "20433",
      "display": "Urography",
      "designation": [
        {
          "language": "fr",
          "value": "Urographie"
        }
      ]
    },
    {
      "code": "20434",
      "display": "Shoulder",
      "designation": [
        {
          "language": "fr",
          "value": "Épaule"
        }
      ]
    },
    {
      "code": "20435",
      "display": "Humerus",
      "designation": [
        {
          "language": "fr",
          "value": "Humérus"
        }
      ]
    },
    {
      "code": "20436",
      "display": "Elbow",
      "designation": [
        {
          "language": "fr",
          "value": "Coude"
        }
      ]
    },
    {
      "code": "20437",
      "display": "Forearm",
      "designation": [
        {
          "language": "fr",
          "value": "Avant-bras"
        }
      ]
    },
    {
      "code": "20438",
      "display": "Wrist",
      "designation": [
        {
          "language": "fr",
          "value": "Poignet"
        }
      ]
    },
    {
      "code": "20439",
      "display": "Hand",
      "designation": [
        {
          "language": "fr",
          "value": "Main"
        }
      ]
    },
    {
      "code": "20440",
      "display": "Bony Pelvis",
      "designation": [
        {
          "language": "fr",
          "value": "Bassin osseux"
        }
      ]
    },
    {
      "code": "20441",
      "display": "Hip",
      "designation": [
        {
          "language": "fr",
          "value": "Hanche"
        }
      ]
    },
    {
      "code": "20442",
      "display": "Femur",
      "designation": [
        {
          "language": "fr",
          "value": "Fémur"
        }
      ]
    },
    {
      "code": "20443",
      "display": "Knee",
      "designation": [
        {
          "language": "fr",
          "value": "Genou"
        }
      ]
    },
    {
      "code": "20444",
      "display": "Tibia and Fibula",
      "designation": [
        {
          "language": "fr",
          "value": "Tibia et fibula"
        }
      ]
    },
    {
      "code": "20445",
      "display": "Ankle",
      "designation": [
        {
          "language": "fr",
          "value": "Cheville"
        }
      ]
    },
    {
      "code": "20446",
      "display": "Foot",
      "designation": [
        {
          "language": "fr",
          "value": "Pied"
        }
      ]
    },
    {
      "code": "20447",
      "display": "Head Angiography",
      "designation": [
        {
          "language": "fr",
          "value": "Angiographie de la tête"
        }
      ]
    },
    {
      "code": "20448",
      "display": "Neck Angiography",
      "designation": [
        {
          "language": "fr",
          "value": "Angiographie du cou"
        }
      ]
    },
    {
      "code": "20449",
      "display": "Chest Angiography",
      "designation": [
        {
          "language": "fr",
          "value": "Angiographie du thorax"
        }
      ]
    },
    {
      "code": "20450",
      "display": "Chest Abdomen Pelvis Angiography",
      "designation": [
        {
          "language": "fr",
          "value": "Angiographie thorax abdomen bassin"
        }
      ]
    },
    {
      "code": "20451",
      "display": "Abdomen Angiography",
      "designation": [
        {
          "language": "fr",
          "value": "Angiographie de l'abdomen"
        }
      ]
    },
    {
      "code": "20452",
      "display": "Abdomen Pelvis Angiography",
      "designation": [
        {
          "language": "fr",
          "value": "Angiographie abdomen bassin"
        }
      ]
    },
    {
      "code": "20453",
      "display": "Pelvis Angiography",
      "designation": [
        {
          "language": "fr",
          "value": "Angiographie du bassin"
        }
      ]
    },
    {
      "code": "20454",
      "display": "Upper Extremity Angiography",
      "designation": [
        {
          "language": "fr",
          "value": "Angiographie des membres supérieurs"
        }
      ]
    },
    {
      "code": "20455",
      "display": "Lower Extremity Angiography",
      "designation": [
        {
          "language": "fr",
          "value": "Angiographie des membres inférieurs"
        }
      ]
    },
    {
      "code": "20456",
      "display": "Head Venography",
      "designation": [
        {
          "language": "fr",
          "value": "Céphalique veineuse"
        }
      ]
    },
    {
      "code": "20464",
      "display": "Cardiac CT",
      "designation": [
        {
          "language": "fr",
          "value": "CT cardiaque"
        }
      ]
    },
    {
      "code": "20465",
      "display": "Coronary Angiography (CCTA)",
      "designation": [
        {
          "language": "fr",
          "value": "Angiographie coronarienne (CCTA)"
        }
      ]
    },
    {
      "code": "20466",
      "display": "Cardiac Calcium Score",
      "designation": [
        {
          "language": "fr",
          "value": "Score calcique cardiaque"
        }
      ]
    },
    {
      "code": "20467",
      "display": "Head",
      "designation": [
        {
          "language": "fr",
          "value": "Tête"
        }
      ]
    },
    {
      "code": "20468",
      "display": "Neck",
      "designation": [
        {
          "language": "fr",
          "value": "Cou"
        }
      ]
    },
    {
      "code": "20469",
      "display": "Spine",
      "designation": [
        {
          "language": "fr",
          "value": "Colonne vertébrale"
        }
      ]
    },
    {
      "code": "20470",
      "display": "Thorax",
      "designation": [
        {
          "language": "fr",
          "value": "Thorax"
        }
      ]
    },
    {
      "code": "20471",
      "display": "Abdomen",
      "designation": [
        {
          "language": "fr",
          "value": "Abdomen"
        }
      ]
    },
    {
      "code": "20472",
      "display": "Pelvis",
      "designation": [
        {
          "language": "fr",
          "value": "Bassin"
        }
      ]
    },
    {
      "code": "20473",
      "display": "Musculoskeletal",
      "designation": [
        {
          "language": "fr",
          "value": "Musculosquelettique"
        }
      ]
    },
    {
      "code": "20474",
      "display": "Angiography",
      "designation": [
        {
          "language": "fr",
          "value": "Angiographie"
        }
      ]
    },
    {
      "code": "20476",
      "display": "Breast",
      "designation": [
        {
          "language": "fr",
          "value": "Sein"
        }
      ]
    },
    {
      "code": "20477",
      "display": "Cardiac",
      "designation": [
        {
          "language": "fr",
          "value": "Cardiaque"
        }
      ]
    },
    {
      "code": "20478",
      "display": "Brain",
      "designation": [
        {
          "language": "fr",
          "value": "Cerveau"
        }
      ]
    },
    {
      "code": "20480",
      "display": "Internal auditory canals",
      "designation": [
        {
          "language": "fr",
          "value": "Canaux auditifs internes"
        }
      ]
    },
    {
      "code": "20481",
      "display": "Orbits",
      "designation": [
        {
          "language": "fr",
          "value": "Orbites"
        }
      ]
    },
    {
      "code": "20482",
      "display": "Pituitary / Sella",
      "designation": [
        {
          "language": "fr",
          "value": "Hypophyse / Sella"
        }
      ]
    },
    {
      "code": "20483",
      "display": "Sinuses",
      "designation": [
        {
          "language": "fr",
          "value": "Sinus"
        }
      ]
    },
    {
      "code": "20484",
      "display": "Temporomandibular joints",
      "designation": [
        {
          "language": "fr",
          "value": "Articulations temporo-mandibulaires"
        }
      ]
    },
    {
      "code": "20485",
      "display": "Trigeminal nerve",
      "designation": [
        {
          "language": "fr",
          "value": "Nerf trijumeau"
        }
      ]
    },
    {
      "code": "20487",
      "display": "Soft Tissue Neck",
      "designation": [
        {
          "language": "fr",
          "value": "Tissu mou du cou"
        }
      ]
    },
    {
      "code": "20488",
      "display": "Brachial plexus",
      "designation": [
        {
          "language": "fr",
          "value": "Plexus brachial"
        }
      ]
    },
    {
      "code": "20489",
      "display": "Whole Spine",
      "designation": [
        {
          "language": "fr",
          "value": "Colonne vertébrale entière"
        }
      ]
    },
    {
      "code": "20490",
      "display": "Cervical Spine",
      "designation": [
        {
          "language": "fr",
          "value": "Colonne cervicale"
        }
      ]
    },
    {
      "code": "20491",
      "display": "Thoracic Spine",
      "designation": [
        {
          "language": "fr",
          "value": "Colonne thoracique"
        }
      ]
    },
    {
      "code": "20492",
      "display": "Lumbar Spine",
      "designation": [
        {
          "language": "fr",
          "value": "Colonne lombaire"
        }
      ]
    },
    {
      "code": "20493",
      "display": "Sacrum/Coccyx",
      "designation": [
        {
          "language": "fr",
          "value": "Sacrum/Coccyx"
        }
      ]
    },
    {
      "code": "20494",
      "display": "Sacroiliac Joints",
      "designation": [
        {
          "language": "fr",
          "value": "Articulations sacro-iliaques"
        }
      ]
    },
    {
      "code": "20495",
      "display": "Chest",
      "designation": [
        {
          "language": "fr",
          "value": "Thorax"
        }
      ]
    },
    {
      "code": "20496",
      "display": "Chest wall",
      "designation": [
        {
          "language": "fr",
          "value": "Paroi thoracique"
        }
      ]
    },
    {
      "code": "20497",
      "display": "Pulmonary arteries",
      "designation": [
        {
          "language": "fr",
          "value": "Artères pulmonaires"
        }
      ]
    },
    {
      "code": "20498",
      "display": "Sternoclavicular joints",
      "designation": [
        {
          "language": "fr",
          "value": "Articulations sternoclaviculaires"
        }
      ]
    },
    {
      "code": "20499",
      "display": "Sternum",
      "designation": [
        {
          "language": "fr",
          "value": "Sternum"
        }
      ]
    },
    {
      "code": "20501",
      "display": "Thoracic Outlet",
      "designation": [
        {
          "language": "fr",
          "value": "Défilé thoracique"
        }
      ]
    },
    {
      "code": "20503",
      "display": "Abdominal wall",
      "designation": [
        {
          "language": "fr",
          "value": "Paroi abdominale"
        }
      ]
    },
    {
      "code": "20504",
      "display": "Adrenal glands",
      "designation": [
        {
          "language": "fr",
          "value": "Glandes surrénales"
        }
      ]
    },
    {
      "code": "20505",
      "display": "Biliary and pancreatic ducts",
      "designation": [
        {
          "language": "fr",
          "value": "Voies biliaires et pancréatiques"
        }
      ]
    },
    {
      "code": "20506",
      "display": "Enterography",
      "designation": [
        {
          "language": "fr",
          "value": "Entérographie"
        }
      ]
    },
    {
      "code": "20507",
      "display": "Kidneys",
      "designation": [
        {
          "language": "fr",
          "value": "Reins"
        }
      ]
    },
    {
      "code": "20508",
      "display": "Liver",
      "designation": [
        {
          "language": "fr",
          "value": "Foie"
        }
      ]
    },
    {
      "code": "20509",
      "display": "Pancreas",
      "designation": [
        {
          "language": "fr",
          "value": "Pancréas"
        }
      ]
    },
    {
      "code": "20510",
      "display": "Renal artery",
      "designation": [
        {
          "language": "fr",
          "value": "Artère rénale"
        }
      ]
    },
    {
      "code": "20511",
      "display": "Urography",
      "designation": [
        {
          "language": "fr",
          "value": "Urographie"
        }
      ]
    },
    {
      "code": "20512",
      "display": "Bladder",
      "designation": [
        {
          "language": "fr",
          "value": "Vessie"
        }
      ]
    },
    {
      "code": "20513",
      "display": "Gynecology (Uterus/ Ovaries/ Adnexal)",
      "designation": [
        {
          "language": "fr",
          "value": "Gynécologie (Utérus/ Ovaires/ Annexes)"
        }
      ]
    },
    {
      "code": "20514",
      "display": "Iliac arteries",
      "designation": [
        {
          "language": "fr",
          "value": "Artères iliaques"
        }
      ]
    },
    {
      "code": "20515",
      "display": "Piriformis",
      "designation": [
        {
          "language": "fr",
          "value": "Piriforme"
        }
      ]
    },
    {
      "code": "20516",
      "display": "Prostate",
      "designation": [
        {
          "language": "fr",
          "value": "Prostate"
        }
      ]
    },
    {
      "code": "20517",
      "display": "Rectum/ Anal",
      "designation": [
        {
          "language": "fr",
          "value": "Rectum/ Anal"
        }
      ]
    },
    {
      "code": "20518",
      "display": "Urogenital (Testicular/ Penile)",
      "designation": [
        {
          "language": "fr",
          "value": "Urogénital (Testiculaire/ Pénien)"
        }
      ]
    },
    {
      "code": "20519",
      "display": "Shoulder",
      "designation": [
        {
          "language": "fr",
          "value": "Épaule"
        }
      ]
    },
    {
      "code": "20520",
      "display": "Humerus",
      "designation": [
        {
          "language": "fr",
          "value": "Humérus"
        }
      ]
    },
    {
      "code": "20521",
      "display": "Elbow",
      "designation": [
        {
          "language": "fr",
          "value": "Coude"
        }
      ]
    },
    {
      "code": "20522",
      "display": "Forearm",
      "designation": [
        {
          "language": "fr",
          "value": "Avant-bras"
        }
      ]
    },
    {
      "code": "20523",
      "display": "Wrist",
      "designation": [
        {
          "language": "fr",
          "value": "Poignet"
        }
      ]
    },
    {
      "code": "20524",
      "display": "Hand",
      "designation": [
        {
          "language": "fr",
          "value": "Main"
        }
      ]
    },
    {
      "code": "20525",
      "display": "Finger"
    },
    {
      "code": "20526",
      "display": "Bony Pelvis",
      "designation": [
        {
          "language": "fr",
          "value": "Bassins osseux"
        }
      ]
    },
    {
      "code": "20527",
      "display": "Hip",
      "designation": [
        {
          "language": "fr",
          "value": "Hanche"
        }
      ]
    },
    {
      "code": "20528",
      "display": "Femur / Thigh",
      "designation": [
        {
          "language": "fr",
          "value": "Fémur / Cuisse"
        }
      ]
    },
    {
      "code": "20529",
      "display": "Knee",
      "designation": [
        {
          "language": "fr",
          "value": "Genou"
        }
      ]
    },
    {
      "code": "20530",
      "display": "Tibia and Fibula",
      "designation": [
        {
          "language": "fr",
          "value": "Tibia et Fibula"
        }
      ]
    },
    {
      "code": "20531",
      "display": "Ankle",
      "designation": [
        {
          "language": "fr",
          "value": "Cheville"
        }
      ]
    },
    {
      "code": "20532",
      "display": "Foot",
      "designation": [
        {
          "language": "fr",
          "value": "Pied"
        }
      ]
    },
    {
      "code": "20533",
      "display": "Toe",
      "designation": [
        {
          "language": "fr",
          "value": "Orteil"
        }
      ]
    },
    {
      "code": "20534",
      "display": "Arthrogram",
      "designation": [
        {
          "language": "fr",
          "value": "Arthrogramme"
        }
      ]
    },
    {
      "code": "20535",
      "display": "Arthrogram",
      "designation": [
        {
          "language": "fr",
          "value": "Arthrogramme"
        }
      ]
    },
    {
      "code": "20536",
      "display": "Arthrogram",
      "designation": [
        {
          "language": "fr",
          "value": "Arthrogramme"
        }
      ]
    },
    {
      "code": "20537",
      "display": "Arthrogram",
      "designation": [
        {
          "language": "fr",
          "value": "Arthrogramme"
        }
      ]
    },
    {
      "code": "20538",
      "display": "Arthrogram",
      "designation": [
        {
          "language": "fr",
          "value": "Arthrogramme"
        }
      ]
    },
    {
      "code": "20539",
      "display": "Arthrogram",
      "designation": [
        {
          "language": "fr",
          "value": "Arthrogramme"
        }
      ]
    },
    {
      "code": "20540",
      "display": "Head Angiography",
      "designation": [
        {
          "language": "fr",
          "value": "Angiographie de la tête"
        }
      ]
    },
    {
      "code": "20541",
      "display": "Neck Angiography",
      "designation": [
        {
          "language": "fr",
          "value": "Angiographie du cou"
        }
      ]
    },
    {
      "code": "20542",
      "display": "Chest Angiography",
      "designation": [
        {
          "language": "fr",
          "value": "Angiographie thoracique"
        }
      ]
    },
    {
      "code": "20543",
      "display": "Abdomen Angiography",
      "designation": [
        {
          "language": "fr",
          "value": "Angiographie abdominale"
        }
      ]
    },
    {
      "code": "20544",
      "display": "Pelvis Angiography",
      "designation": [
        {
          "language": "fr",
          "value": "Angiographie pelvienne"
        }
      ]
    },
    {
      "code": "20545",
      "display": "Upper Extremity Angiography",
      "designation": [
        {
          "language": "fr",
          "value": "Angiographie des membres supérieurs"
        }
      ]
    },
    {
      "code": "20546",
      "display": "Lower Extremity Angiography",
      "designation": [
        {
          "language": "fr",
          "value": "Angiographie des membres inférieurs"
        }
      ]
    },
    {
      "code": "20554",
      "display": "Diagnostic",
      "designation": [
        {
          "language": "fr",
          "value": "Diagnostique"
        }
      ]
    },
    {
      "code": "20555",
      "display": "Implant",
      "designation": [
        {
          "language": "fr",
          "value": "Implant"
        }
      ]
    },
    {
      "code": "20556",
      "display": "Chest (default Chest 2 views)",
      "designation": [
        {
          "language": "fr",
          "value": "Thorax (par défaut Thorax 2 vues)"
        }
      ]
    },
    {
      "code": "20557",
      "display": "Abdomen",
      "designation": [
        {
          "language": "fr",
          "value": "Abdomen"
        }
      ]
    },
    {
      "code": "20558",
      "display": "Spine",
      "designation": [
        {
          "language": "fr",
          "value": "Colonne vertébrale"
        }
      ]
    },
    {
      "code": "20559",
      "display": "Head and Neck",
      "designation": [
        {
          "language": "fr",
          "value": "Tête et cou"
        }
      ]
    },
    {
      "code": "20560",
      "display": "Upper Extremities",
      "designation": [
        {
          "language": "fr",
          "value": "Membres supérieurs"
        }
      ]
    },
    {
      "code": "20561",
      "display": "Lower Extremities",
      "designation": [
        {
          "language": "fr",
          "value": "Membres inférieurs"
        }
      ]
    },
    {
      "code": "20562",
      "display": "Mammogram (Non-OBSP)",
      "designation": [
        {
          "language": "fr",
          "value": "Mammographie (Non-OBSP)"
        }
      ]
    },
    {
      "code": "20563",
      "display": "Bone Age",
      "designation": [
        {
          "language": "fr",
          "value": "Âge osseux"
        }
      ]
    },
    {
      "code": "20564",
      "display": "Survey",
      "designation": [
        {
          "language": "fr",
          "value": "Examen général"
        }
      ]
    },
    {
      "code": "20565",
      "display": "Gastric and Fluoroscopic imaging",
      "designation": [
        {
          "language": "fr",
          "value": "Imagerie gastrique et fluoroscopique"
        }
      ]
    },
    {
      "code": "20566",
      "display": "One view (PA)",
      "designation": [
        {
          "language": "fr",
          "value": "Une vue (PA)"
        }
      ]
    },
    {
      "code": "20567",
      "display": "Two Views (PA, Lat)",
      "designation": [
        {
          "language": "fr",
          "value": "Deux vues (PA, Lat)"
        }
      ]
    },
    {
      "code": "20568",
      "display": "Three views (PA inspiration, PA expiration, Lat)",
      "designation": [
        {
          "language": "fr",
          "value": "Trois vues (PA inspiration, PA expiration, Lat)"
        }
      ]
    },
    {
      "code": "20569",
      "display": "Sternum",
      "designation": [
        {
          "language": "fr",
          "value": "Sternum"
        }
      ]
    },
    {
      "code": "20570",
      "display": "Ribs",
      "designation": [
        {
          "language": "fr",
          "value": "Côtes"
        }
      ]
    },
    {
      "code": "20571",
      "display": "Thoracic inlet",
      "designation": [
        {
          "language": "fr",
          "value": "Orifice thoracique"
        }
      ]
    },
    {
      "code": "20572",
      "display": "Sternoclavicular Joints",
      "designation": [
        {
          "language": "fr",
          "value": "Articulations sternoclaviculaires"
        }
      ]
    },
    {
      "code": "20573",
      "display": "One view (Supine)",
      "designation": [
        {
          "language": "fr",
          "value": "Une vue (Décubitus)"
        }
      ]
    },
    {
      "code": "20574",
      "display": "One view (Upright)",
      "designation": [
        {
          "language": "fr",
          "value": "Une vue (Debout)"
        }
      ]
    },
    {
      "code": "20575",
      "display": "KUB (Kidney Ureters Bladder)",
      "designation": [
        {
          "language": "fr",
          "value": "KUB (Rein Uretères Vessie)"
        }
      ]
    },
    {
      "code": "20576",
      "display": "Cervical",
      "designation": [
        {
          "language": "fr",
          "value": "Cervical"
        }
      ]
    },
    {
      "code": "20577",
      "display": "Cervical spine flexion extension",
      "designation": [
        {
          "language": "fr",
          "value": "Flexion extension de la colonne cervicale"
        }
      ]
    },
    {
      "code": "20578",
      "display": "Thoracic",
      "designation": [
        {
          "language": "fr",
          "value": "Thoracique"
        }
      ]
    },
    {
      "code": "20579",
      "display": "Lumbar",
      "designation": [
        {
          "language": "fr",
          "value": "Lombaire"
        }
      ]
    },
    {
      "code": "20580",
      "display": "Lumbar spine flexion extension",
      "designation": [
        {
          "language": "fr",
          "value": "Flexion extension de la colonne lombaire"
        }
      ]
    },
    {
      "code": "20581",
      "display": "Sacrum",
      "designation": [
        {
          "language": "fr",
          "value": "Sacrum"
        }
      ]
    },
    {
      "code": "20582",
      "display": "Coccyx",
      "designation": [
        {
          "language": "fr",
          "value": "Coccyx"
        }
      ]
    },
    {
      "code": "20583",
      "display": "Sacroiliac joints",
      "designation": [
        {
          "language": "fr",
          "value": "Articulations sacro-iliaques"
        }
      ]
    },
    {
      "code": "20584",
      "display": "Scoliosis spine",
      "designation": [
        {
          "language": "fr",
          "value": "Colonne vertébrale scoliose"
        }
      ]
    },
    {
      "code": "20585",
      "display": "Skull",
      "designation": [
        {
          "language": "fr",
          "value": "Crâne"
        }
      ]
    },
    {
      "code": "20586",
      "display": "Orbits",
      "designation": [
        {
          "language": "fr",
          "value": "Orbites"
        }
      ]
    },
    {
      "code": "20587",
      "display": "Neck for soft tissue",
      "designation": [
        {
          "language": "fr",
          "value": "Cou pour les tissus mous"
        }
      ]
    },
    {
      "code": "20588",
      "display": "Mastoids",
      "designation": [
        {
          "language": "fr",
          "value": "Mastoïdes"
        }
      ]
    },
    {
      "code": "20589",
      "display": "Nasal bones",
      "designation": [
        {
          "language": "fr",
          "value": "Os nasaux"
        }
      ]
    },
    {
      "code": "20590",
      "display": "Facal bones",
      "designation": [
        {
          "language": "fr",
          "value": "Os faciaux"
        }
      ]
    },
    {
      "code": "20591",
      "display": "Mandible",
      "designation": [
        {
          "language": "fr",
          "value": "Mandibule"
        }
      ]
    },
    {
      "code": "20592",
      "display": "Temporomandibular joints",
      "designation": [
        {
          "language": "fr",
          "value": "Articulations temporo-mandibulaires"
        }
      ]
    },
    {
      "code": "20593",
      "display": "Sinus",
      "designation": [
        {
          "language": "fr",
          "value": "Sinus"
        }
      ]
    },
    {
      "code": "20594",
      "display": "Trauma or injury",
      "designation": [
        {
          "language": "fr",
          "value": "Traumatisme ou blessure"
        }
      ]
    },
    {
      "code": "20595",
      "display": "Eye for foreign body",
      "designation": [
        {
          "language": "fr",
          "value": "Œil pour corps étranger"
        }
      ]
    },
    {
      "code": "20596",
      "display": "Shoulder",
      "designation": [
        {
          "language": "fr",
          "value": "Épaule"
        }
      ]
    },
    {
      "code": "20597",
      "display": "Clavicle",
      "designation": [
        {
          "language": "fr",
          "value": "Clavicule"
        }
      ]
    },
    {
      "code": "20598",
      "display": "Acromioclavicular joints",
      "designation": [
        {
          "language": "fr",
          "value": "Articulations acromioclaviculaires"
        }
      ]
    },
    {
      "code": "20599",
      "display": "Scapula",
      "designation": [
        {
          "language": "fr",
          "value": "Omoplate"
        }
      ]
    },
    {
      "code": "20600",
      "display": "Humerus",
      "designation": [
        {
          "language": "fr",
          "value": "Humérus"
        }
      ]
    },
    {
      "code": "20601",
      "display": "Elbow",
      "designation": [
        {
          "language": "fr",
          "value": "Coude"
        }
      ]
    },
    {
      "code": "20602",
      "display": "Forearm",
      "designation": [
        {
          "language": "fr",
          "value": "Avant-bras"
        }
      ]
    },
    {
      "code": "20603",
      "display": "Wrist",
      "designation": [
        {
          "language": "fr",
          "value": "Poignet"
        }
      ]
    },
    {
      "code": "20604",
      "display": "Scaphoid",
      "designation": [
        {
          "language": "fr",
          "value": "Scaphoïde"
        }
      ]
    },
    {
      "code": "20605",
      "display": "Hand",
      "designation": [
        {
          "language": "fr",
          "value": "Main"
        }
      ]
    },
    {
      "code": "20606",
      "display": "Finger",
      "designation": [
        {
          "language": "fr",
          "value": "Doigt"
        }
      ]
    },
    {
      "code": "20607",
      "display": "Pelvis",
      "designation": [
        {
          "language": "fr",
          "value": "Bassins"
        }
      ]
    },
    {
      "code": "20608",
      "display": "Hip",
      "designation": [
        {
          "language": "fr",
          "value": "Hanche"
        }
      ]
    },
    {
      "code": "20609",
      "display": "Femur",
      "designation": [
        {
          "language": "fr",
          "value": "Fémur"
        }
      ]
    },
    {
      "code": "20610",
      "display": "Knee",
      "designation": [
        {
          "language": "fr",
          "value": "Genou"
        }
      ]
    },
    {
      "code": "20611",
      "display": "Patella",
      "designation": [
        {
          "language": "fr",
          "value": "Rotule"
        }
      ]
    },
    {
      "code": "20612",
      "display": "Tibia and fibula",
      "designation": [
        {
          "language": "fr",
          "value": "Tibia et fibula"
        }
      ]
    },
    {
      "code": "20613",
      "display": "Ankle",
      "designation": [
        {
          "language": "fr",
          "value": "Cheville"
        }
      ]
    },
    {
      "code": "20614",
      "display": "Foot",
      "designation": [
        {
          "language": "fr",
          "value": "Pied"
        }
      ]
    },
    {
      "code": "20615",
      "display": "Calcaneus",
      "designation": [
        {
          "language": "fr",
          "value": "Calcanéum"
        }
      ]
    },
    {
      "code": "20616",
      "display": "Toes",
      "designation": [
        {
          "language": "fr",
          "value": "Orteils"
        }
      ]
    },
    {
      "code": "20617",
      "display": "Leg length",
      "designation": [
        {
          "language": "fr",
          "value": "Longueur de jambe"
        }
      ]
    },
    {
      "code": "20618",
      "display": "Metabolic",
      "designation": [
        {
          "language": "fr",
          "value": "Métabolique"
        }
      ]
    },
    {
      "code": "20619",
      "display": "Metastatic",
      "designation": [
        {
          "language": "fr",
          "value": "Métastatique"
        }
      ]
    },
    {
      "code": "20620",
      "display": "Rheumatoid",
      "designation": [
        {
          "language": "fr",
          "value": "Rhumatoïde"
        }
      ]
    },
    {
      "code": "20621",
      "display": "Babygram",
      "designation": [
        {
          "language": "fr",
          "value": "Radiographie du bébé"
        }
      ]
    },
    {
      "code": "20622",
      "display": "Gastrointestinal tract",
      "designation": [
        {
          "language": "fr",
          "value": "Tube gastro-intestinal"
        }
      ]
    },
    {
      "code": "20623",
      "display": "Retrograde urethrogram",
      "designation": [
        {
          "language": "fr",
          "value": "Uréthrogramme rétrograde"
        }
      ]
    },
    {
      "code": "20624",
      "display": "Cystourethrogram",
      "designation": [
        {
          "language": "fr",
          "value": "Cystouréthrogramme"
        }
      ]
    },
    {
      "code": "20625",
      "display": "Hysterosalpingogram",
      "designation": [
        {
          "language": "fr",
          "value": "Hystérosalpingogramme"
        }
      ]
    },
    {
      "code": "20626",
      "display": "Sinogram",
      "designation": [
        {
          "language": "fr",
          "value": "Sinogramme"
        }
      ]
    },
    {
      "code": "20627",
      "display": "Musculoskeletal injections",
      "designation": [
        {
          "language": "fr",
          "value": "Injections musculosquelettiques"
        }
      ]
    },
    {
      "code": "20628",
      "display": "Modified barium swallow (Video fluoroscope swallowing exam)",
      "designation": [
        {
          "language": "fr",
          "value": "Déglutition au baryum modifiée (Examen de déglutition par fluoroscope vidéo)"
        }
      ]
    },
    {
      "code": "20629",
      "display": "Barium swallow",
      "designation": [
        {
          "language": "fr",
          "value": "Déglutition au baryum"
        }
      ]
    },
    {
      "code": "20630",
      "display": "Upper GI series (Esophagus, stomach and duodenum)",
      "designation": [
        {
          "language": "fr",
          "value": "Série GI supérieure (Œsophage, estomac et duodénum)"
        }
      ]
    },
    {
      "code": "20631",
      "display": "Small bowel follow through",
      "designation": [
        {
          "language": "fr",
          "value": "Suivi de l'intestin grêle"
        }
      ]
    },
    {
      "code": "20632",
      "display": "Barium enema",
      "designation": [
        {
          "language": "fr",
          "value": "Lavement baryté"
        }
      ]
    },
    {
      "code": "20633",
      "display": "Stress",
      "designation": [
        {
          "language": "fr",
          "value": "Stress"
        }
      ]
    },
    {
      "code": "20634",
      "display": "Voiding",
      "designation": [
        {
          "language": "fr",
          "value": "Miction"
        }
      ]
    },
    {
      "code": "20635",
      "display": "Abdomen",
      "designation": [
        {
          "language": "fr",
          "value": "Abdomen"
        }
      ]
    },
    {
      "code": "20636",
      "display": "Pelvis",
      "designation": [
        {
          "language": "fr",
          "value": "Bassins"
        }
      ]
    },
    {
      "code": "20637",
      "display": "Obstetrical",
      "designation": [
        {
          "language": "fr",
          "value": "Obstétrical"
        }
      ]
    },
    {
      "code": "20638",
      "display": "Neonatal and Paediatric",
      "designation": [
        {
          "language": "fr",
          "value": "Néonatal et pédiatrique"
        }
      ]
    },
    {
      "code": "20639",
      "display": "Musculoskeletal",
      "designation": [
        {
          "language": "fr",
          "value": "Musculosquelettique"
        }
      ]
    },
    {
      "code": "20640",
      "display": "Vascular",
      "designation": [
        {
          "language": "fr",
          "value": "Vasculaire"
        }
      ]
    },
    {
      "code": "20641",
      "display": "Head and Neck",
      "designation": [
        {
          "language": "fr",
          "value": "Tête et cou"
        }
      ]
    },
    {
      "code": "20642",
      "display": "Breast and Axilla",
      "designation": [
        {
          "language": "fr",
          "value": "Sein et aisselle"
        }
      ]
    },
    {
      "code": "20643",
      "display": "Complete abdomen",
      "designation": [
        {
          "language": "fr",
          "value": "Abdomen complet"
        }
      ]
    },
    {
      "code": "20644",
      "display": "Appendix",
      "designation": [
        {
          "language": "fr",
          "value": "Appendice"
        }
      ]
    },
    {
      "code": "20645",
      "display": "Gallbladder",
      "designation": [
        {
          "language": "fr",
          "value": "Vésicule biliaire"
        }
      ]
    },
    {
      "code": "20646",
      "display": "Kidney Ureters Bladder",
      "designation": [
        {
          "language": "fr",
          "value": "Rein Uretères Vessie"
        }
      ]
    },
    {
      "code": "20647",
      "display": "Liver",
      "designation": [
        {
          "language": "fr",
          "value": "Foie"
        }
      ]
    },
    {
      "code": "20648",
      "display": "Liver elastography",
      "designation": [
        {
          "language": "fr",
          "value": "Élastographie du foie"
        }
      ]
    },
    {
      "code": "20649",
      "display": "Pancreas",
      "designation": [
        {
          "language": "fr",
          "value": "Pancréas"
        }
      ]
    },
    {
      "code": "20650",
      "display": "Portal hypertension",
      "designation": [
        {
          "language": "fr",
          "value": "Hypertension portale"
        }
      ]
    },
    {
      "code": "20651",
      "display": "Renal",
      "designation": [
        {
          "language": "fr",
          "value": "Rénal"
        }
      ]
    },
    {
      "code": "20652",
      "display": "Right upper quadrant",
      "designation": [
        {
          "language": "fr",
          "value": "Quadrant supérieur droit"
        }
      ]
    },
    {
      "code": "20653",
      "display": "Spleen",
      "designation": [
        {
          "language": "fr",
          "value": "Rate"
        }
      ]
    },
    {
      "code": "20654",
      "display": "Abdomen contrast",
      "designation": [
        {
          "language": "fr",
          "value": "Abdomen avec contraste"
        }
      ]
    },
    {
      "code": "20655",
      "display": "Abdominal wall",
      "designation": [
        {
          "language": "fr",
          "value": "Paroi abdominale"
        }
      ]
    },
    {
      "code": "20656",
      "display": "Complete pelvis",
      "designation": [
        {
          "language": "fr",
          "value": "Bassins complet"
        }
      ]
    },
    {
      "code": "20657",
      "display": "Pelvis transabdominal",
      "designation": [
        {
          "language": "fr",
          "value": "Bassins transabdominal"
        }
      ]
    },
    {
      "code": "20658",
      "display": "Female pelvis (transvaginal)",
      "designation": [
        {
          "language": "fr",
          "value": "Bassins féminin (transvaginal)"
        }
      ]
    },
    {
      "code": "20659",
      "display": "Follicular monitoring",
      "designation": [
        {
          "language": "fr",
          "value": "Surveillance folliculaire"
        }
      ]
    },
    {
      "code": "20660",
      "display": "Limited non-pregnancy (for IUD insertion placement check)",
      "designation": [
        {
          "language": "fr",
          "value": "Non-grossesse limitée (pour vérification de l'insertion du DIU)"
        }
      ]
    },
    {
      "code": "20661",
      "display": "Saline Infusion Sonohysterography",
      "designation": [
        {
          "language": "fr",
          "value": "Sonohystérographie par perfusion de sérum physiologique"
        }
      ]
    },
    {
      "code": "20662",
      "display": "Male pelvis (Transrectal)",
      "designation": [
        {
          "language": "fr",
          "value": "Bassins masculin (transrectal)"
        }
      ]
    },
    {
      "code": "20663",
      "display": "Prostate",
      "designation": [
        {
          "language": "fr",
          "value": "Prostate"
        }
      ]
    },
    {
      "code": "20664",
      "display": "Penile",
      "designation": [
        {
          "language": "fr",
          "value": "Pénien"
        }
      ]
    },
    {
      "code": "20665",
      "display": "Testicles/Scrotum",
      "designation": [
        {
          "language": "fr",
          "value": "Testicules/Scrotum"
        }
      ]
    },
    {
      "code": "20666",
      "display": "Bladder",
      "designation": [
        {
          "language": "fr",
          "value": "Vessie"
        }
      ]
    },
    {
      "code": "20667",
      "display": "Groin",
      "designation": [
        {
          "language": "fr",
          "value": "Aine"
        }
      ]
    },
    {
      "code": "20668",
      "display": "Singleton",
      "designation": [
        {
          "language": "fr",
          "value": "Grossesse unique"
        }
      ]
    },
    {
      "code": "20669",
      "display": "Twins",
      "designation": [
        {
          "language": "fr",
          "value": "Jumeaux"
        }
      ]
    },
    {
      "code": "20670",
      "display": "Triplets",
      "designation": [
        {
          "language": "fr",
          "value": "Triplés"
        }
      ]
    },
    {
      "code": "20671",
      "display": "Unknown",
      "designation": [
        {
          "language": "fr",
          "value": "Inconnu"
        }
      ]
    },
    {
      "code": "20672",
      "display": "Dating (<16 weeks)",
      "designation": [
        {
          "language": "fr",
          "value": "Datation (<16 semaines)"
        }
      ]
    },
    {
      "code": "20673",
      "display": "Prenatal screening (NT/eFTS) 11-14 weeks",
      "designation": [
        {
          "language": "fr",
          "value": "Dépistage prénatal (NT/eFTS) 11-14 semaines"
        }
      ]
    },
    {
      "code": "20674",
      "display": "Anatomy (20 week scan)",
      "designation": [
        {
          "language": "fr",
          "value": "Anatomie (échographie de 20 semaines)"
        }
      ]
    },
    {
      "code": "20675",
      "display": "2nd or 3rd trimester scan",
      "designation": [
        {
          "language": "fr",
          "value": "Échographie du 2e ou 3e trimestre"
        }
      ]
    },
    {
      "code": "20676",
      "display": "Biophysical profile",
      "designation": [
        {
          "language": "fr",
          "value": "Profil bio-physique"
        }
      ]
    },
    {
      "code": "20677",
      "display": "Growth",
      "designation": [
        {
          "language": "fr",
          "value": "Croissance"
        }
      ]
    },
    {
      "code": "20678",
      "display": "Cervical length",
      "designation": [
        {
          "language": "fr",
          "value": "Longueur cervicale"
        }
      ]
    },
    {
      "code": "20745",
      "display": "With transvaginal",
      "designation": [
        {
          "language": "fr",
          "value": "Avec transvaginal"
        }
      ]
    },
    {
      "code": "20679",
      "display": "Multi-gestational study",
      "designation": [
        {
          "language": "fr",
          "value": "Étude multi-gestationnelle"
        }
      ]
    },
    {
      "code": "20680",
      "display": "High risk pregnancy",
      "designation": [
        {
          "language": "fr",
          "value": "Grossesse à haut risque"
        }
      ]
    },
    {
      "code": "20681",
      "display": "Uterine artery doppler studies",
      "designation": [
        {
          "language": "fr",
          "value": "Études Doppler de l'artère utérine"
        }
      ]
    },
    {
      "code": "20682",
      "display": "Umbilical artery doppler studies",
      "designation": [
        {
          "language": "fr",
          "value": "Études Doppler de l'artère ombilicale"
        }
      ]
    },
    {
      "code": "20683",
      "display": "Fetal doppler",
      "designation": [
        {
          "language": "fr",
          "value": "Doppler fœtal"
        }
      ]
    },
    {
      "code": "20684",
      "display": "Report sex",
      "designation": [
        {
          "language": "fr",
          "value": "Indiquer le sexe"
        }
      ]
    },
    {
      "code": "20685",
      "display": "1st Trimester"
    },
    {
      "code": "20686",
      "display": "2nd and 3rd Trimester"
    },
    {
      "code": "20687",
      "display": "Pylorus"
    },
    {
      "code": "20688",
      "display": "Spine"
    },
    {
      "code": "20689",
      "display": "Brain"
    },
    {
      "code": "20690",
      "display": "Hips"
    },
    {
      "code": "20691",
      "display": "Pylorus and Hypertrophic Pyloric Stenosis"
    },
    {
      "code": "20692",
      "display": "Bowel"
    },
    {
      "code": "20693",
      "display": "Foot"
    },
    {
      "code": "20694",
      "display": "Plantar fascia"
    },
    {
      "code": "20695",
      "display": "Ankle"
    },
    {
      "code": "20696",
      "display": "Achilles"
    },
    {
      "code": "20697",
      "display": "Calf/Lower leg/Gastrocnemius"
    },
    {
      "code": "20698",
      "display": "Knee"
    },
    {
      "code": "20699",
      "display": "Patellar tendon"
    },
    {
      "code": "20700",
      "display": "Popliteal fossa"
    },
    {
      "code": "20701",
      "display": "Quadriceps tendon"
    },
    {
      "code": "20702",
      "display": "Thigh/Hamstrings"
    },
    {
      "code": "20703",
      "display": "Hip"
    },
    {
      "code": "20704",
      "display": "Gluteal region"
    },
    {
      "code": "20705",
      "display": "Hand"
    },
    {
      "code": "20706",
      "display": "Wrist"
    },
    {
      "code": "20707",
      "display": "Carpal tunnel"
    },
    {
      "code": "20708",
      "display": "Forearm"
    },
    {
      "code": "20709",
      "display": "Elbow"
    },
    {
      "code": "20710",
      "display": "Biceps"
    },
    {
      "code": "20711",
      "display": "Triceps"
    },
    {
      "code": "20712",
      "display": "Shoulders"
    },
    {
      "code": "20713",
      "display": "Rotator cuff"
    },
    {
      "code": "20714",
      "display": "Toe(s)"
    },
    {
      "code": "20715",
      "display": "Finger(s)"
    },
    {
      "code": "20716",
      "display": "Palpable masses"
    },
    {
      "code": "20717",
      "display": "Foreign body"
    },
    {
      "code": "20718",
      "display": "Upper extremity arterial"
    },
    {
      "code": "20719",
      "display": "Upper extremity venous"
    },
    {
      "code": "20720",
      "display": "Lower extremity arterial"
    },
    {
      "code": "20721",
      "display": "Lower extremity venous thrombosis"
    },
    {
      "code": "20722",
      "display": "Lower extremity venous reflux"
    },
    {
      "code": "20723",
      "display": "Abdominal aortic aneurysm screen"
    },
    {
      "code": "20724",
      "display": "Ankle brachial index"
    },
    {
      "code": "20725",
      "display": "Arterial venous fistula"
    },
    {
      "code": "20726",
      "display": "Carotid"
    },
    {
      "code": "20727",
      "display": "Inferior vena cava"
    },
    {
      "code": "20728",
      "display": "Portal vein"
    },
    {
      "code": "20729",
      "display": "Renal arteries"
    },
    {
      "code": "20730",
      "display": "Superior mesenteric artery (SMA)"
    },
    {
      "code": "20731",
      "display": "Temporal arteries"
    },
    {
      "code": "20732",
      "display": "Venous mapping"
    },
    {
      "code": "20733",
      "display": "Neck/Salivary gland"
    },
    {
      "code": "20734",
      "display": "Lymph nodes"
    },
    {
      "code": "20735",
      "display": "Thyroid"
    },
    {
      "code": "20736",
      "display": "Breast"
    },
    {
      "code": "20737",
      "display": "Axilla"
    },
    {
      "code": "20738",
      "display": "Chest"
    },
    {
      "code": "20739",
      "display": "Chest wall (mass)"
    },
    {
      "code": "20740",
      "display": "Soft tissue"
    },
    {
      "code": "20741",
      "display": "Baseline"
    },
    {
      "code": "20742",
      "display": "Low Risk"
    },
    {
      "code": "20743",
      "display": "High Risk"
    },
    {
      "code": "20748",
      "display": "Breast"
    },
    {
      "code": "20749",
      "display": "Burns and Sequelae"
    },
    {
      "code": "20750",
      "display": "Congenital Conditions"
    },
    {
      "code": "20751",
      "display": "Facial Trauma and Reconstruction"
    },
    {
      "code": "20752",
      "display": "Gender-Affirming Surgery"
    },
    {
      "code": "20753",
      "display": "Hand and Upper Limb"
    },
    {
      "code": "20754",
      "display": "Peripheral Nerve, Carpal Tunnel Syndrome, and Brachial Plexus"
    },
    {
      "code": "20755",
      "display": "Skin Lesions and Skin Cancer"
    },
    {
      "code": "20756",
      "display": "Soft Tissue Tumours"
    },
    {
      "code": "20757",
      "display": "Wound - Acute"
    },
    {
      "code": "20758",
      "display": "Wound - Chronic / Complex"
    },
    {
      "code": "20759",
      "display": "Breast Reduction"
    },
    {
      "code": "20760",
      "display": "Gynecomastia"
    },
    {
      "code": "20761",
      "display": "Post-Mastectomy Reconstruction"
    },
    {
      "code": "20762",
      "display": "Revision of Prior Breast-Surgery"
    },
    {
      "code": "20763",
      "display": "Acute Burns"
    },
    {
      "code": "20764",
      "display": "Burn Scar Contracture"
    },
    {
      "code": "20765",
      "display": "Non-Healing Burn Wounds"
    },
    {
      "code": "20766",
      "display": "Scar Revision"
    },
    {
      "code": "20767",
      "display": "Date of Injury / Onset"
    },
    {
      "code": "20768",
      "display": "Cleft Lip / Palate"
    },
    {
      "code": "20769",
      "display": "Craniofacial Anomalies"
    },
    {
      "code": "20770",
      "display": "Ear Anomalies"
    },
    {
      "code": "20771",
      "display": "Hand Anomalies"
    },
    {
      "code": "20772",
      "display": "Vascular Anomaly / Malformation"
    },
    {
      "code": "20773",
      "display": "Acute Facial Fractures"
    },
    {
      "code": "20774",
      "display": "Acute Soft Tissue Injuries"
    },
    {
      "code": "20775",
      "display": "Reconstruction After Trauma"
    },
    {
      "code": "20776",
      "display": "Chest (Top) Surgery"
    },
    {
      "code": "20777",
      "display": "Facial Gender-Affirming Surgery"
    },
    {
      "code": "20778",
      "display": "Genital (Bottom) Surgery"
    },
    {
      "code": "20780",
      "display": "Fracture - Acute"
    },
    {
      "code": "20781",
      "display": "Hand Osteoarthritis (with deformity/pain/loss of function)"
    },
    {
      "code": "20782",
      "display": "Malunion / Non-union of Fractures"
    },
    {
      "code": "20783",
      "display": "Tendon Injury - Acute"
    },
    {
      "code": "20785",
      "display": "Brachial Plexus - Congenital Condition"
    },
    {
      "code": "20786",
      "display": "Brachial Plexus - Traumatic Injury"
    },
    {
      "code": "20788",
      "display": "Cubital Tunnel Syndrome"
    },
    {
      "code": "20789",
      "display": "Peripheral Nerve Injury"
    },
    {
      "code": "20790",
      "display": "Peripheral Nerve Tumour"
    },
    {
      "code": "20791",
      "display": "Basal Cell Carcinoma"
    },
    {
      "code": "20792",
      "display": "Squamous Cell Carcinoma"
    },
    {
      "code": "20794",
      "display": "Benign or Symptomatic Lesion(s) (e.g. epidermal cysts, superficial lipomas)"
    },
    {
      "code": "20796",
      "display": "Post-Cancer Reconstruction"
    },
    {
      "code": "20798",
      "display": "Soft Tissue Sarcoma"
    },
    {
      "code": "20800",
      "display": "Complex Wound (e.g., mixed etiology, non-healing, exposed structures)"
    },
    {
      "code": "20801",
      "display": "Diabetic / Ischemic Foot Ulcer"
    },
    {
      "code": "20802",
      "display": "Pressure Injury"
    },
    {
      "code": "20803",
      "display": "Surgical Wound - Non-Healing"
    },
    {
      "code": "20804",
      "display": "Venous Leg Ulcer"
    },
    {
      "code": "20805",
      "display": "Anxiety or Panic Symptoms"
    },
    {
      "code": "20806",
      "display": "Attention, Focus or Cognitive Processing Problems"
    },
    {
      "code": "20807",
      "display": "Behavioural Addictions (e.g., gambling, gaming, internet use, sexual)"
    },
    {
      "code": "20808",
      "display": "Bipolar / Mania Symptoms"
    },
    {
      "code": "20809",
      "display": "Dementia-Related Behaviours"
    },
    {
      "code": "20810",
      "display": "Depression Symptoms or Low Mood"
    },
    {
      "code": "20811",
      "display": "Eating Concerns (e.g., restricted or binge eating)"
    },
    {
      "code": "20812",
      "display": "Emotional Dysregulation (e.g., anger, aggression, mood swings)"
    },
    {
      "code": "20813",
      "display": "Hyperactivity or Impulsivity"
    },
    {
      "code": "20814",
      "display": "Intellectual Disability"
    },
    {
      "code": "20815",
      "display": "Memory Concerns"
    },
    {
      "code": "20816",
      "display": "Neurodevelopmental Concerns (e.g., autism-spectrum, ADHD)"
    },
    {
      "code": "20817",
      "display": "Obsessions or Compulsions"
    },
    {
      "code": "20818",
      "display": "Personality-Related Concerns (e.g., unstable relationships, chronic conflict with others)"
    },
    {
      "code": "20819",
      "display": "Psychotic Symptoms (e.g., hallucinations, delusions, etc.)"
    },
    {
      "code": "20820",
      "display": "Substance Use Concerns"
    },
    {
      "code": "20821",
      "display": "Trauma-Related Symptoms / PTSD (e.g., hypervigilance, flashbacks)"
    },
    {
      "code": "20822",
      "display": "Height (cm)"
    },
    {
      "code": "20823",
      "display": "Weight (kg)"
    },
    {
      "code": "20824",
      "display": "BMI"
    },
    {
      "code": "20825",
      "display": "Homicidal Ideation / Threats"
    },
    {
      "code": "20826",
      "display": "Self-Harm Behaviours"
    },
    {
      "code": "20827",
      "display": "Suicidal Ideation or Attempt"
    },
    {
      "code": "20828",
      "display": "Violence or Aggression"
    },
    {
      "code": "20829",
      "display": "Housing Instability"
    },
    {
      "code": "20830",
      "display": "Legal Involvement / History"
    },
    {
      "code": "20832",
      "display": "Behavioural Addictions (e.g., gambling, internet use, gaming, sexual)"
    },
    {
      "code": "20836",
      "display": "Difficulty coping with life stressors (e.g. grief, loss)"
    },
    {
      "code": "20841",
      "display": "Psychotic Symptoms"
    },
    {
      "code": "20844",
      "display": "Current Weight (kgs)"
    },
    {
      "code": "20845",
      "display": "Current Weight (lbs)"
    },
    {
      "code": "20846",
      "display": "Current Height (cm)"
    },
    {
      "code": "20848",
      "display": "Blood Pressure"
    },
    {
      "code": "20849",
      "display": "Heart Rate"
    },
    {
      "code": "20850",
      "display": "Date of LMP"
    },
    {
      "code": "20851",
      "display": "Food Intake Restrictions"
    },
    {
      "code": "20852",
      "display": "Binge Eating"
    },
    {
      "code": "20853",
      "display": "Induced Vomiting"
    },
    {
      "code": "20854",
      "display": "Laxative Use"
    },
    {
      "code": "20855",
      "display": "Exercise Quantity (per week)"
    },
    {
      "code": "20856",
      "display": "Chewing and Spitting"
    },
    {
      "code": "20857",
      "display": "Diet Medications"
    },
    {
      "code": "20858",
      "display": "First Episode Psychosis"
    },
    {
      "code": "20859",
      "display": "Case Management"
    },
    {
      "code": "20860",
      "display": "Counselling / Psychotherapy Services"
    },
    {
      "code": "20861",
      "display": "Psychiatric Consultation"
    },
    {
      "code": "20862",
      "display": "Diagnostic Clarification"
    },
    {
      "code": "20863",
      "display": "Interventional Psychiatry"
    },
    {
      "code": "20864",
      "display": "Medication / Treatment Recommendations"
    },
    {
      "code": "20865",
      "display": "Electroconvulsive therapy (ECT)"
    },
    {
      "code": "20866",
      "display": "Repetitive Transcranial Magnetic Stimulation (rTMS)"
    },
    {
      "code": "20867",
      "display": "Family Support Services"
    },
    {
      "code": "20868",
      "display": "Peer Support Services"
    },
    {
      "code": "20869",
      "display": "Supportive Housing"
    },
    {
      "code": "20870",
      "display": "Bed-Based Addiction Treatment (formerly known as Residential Addiction Services)"
    },
    {
      "code": "20871",
      "display": "Substance Use / Addiction Treatment"
    },
    {
      "code": "20872",
      "display": "Stabilization on Opioid Agonist Therapy"
    },
    {
      "code": "20873",
      "display": "Withdrawal Management"
    },
    {
      "code": "20874",
      "display": "Court Support"
    },
    {
      "code": "20875",
      "display": "Possible Safety Concern to Others (e.g. aggression, homicidal threats or ideation)"
    },
    {
      "code": "20879",
      "display": "Legal Involvement / Court Orders (e.g. current charges, probation, parole, CTO/ORB conditions)"
    },
    {
      "code": "20880",
      "display": "Bone and Joint Infections"
    },
    {
      "code": "20881",
      "display": "Clostridioides difficile (C. diff)"
    },
    {
      "code": "20882",
      "display": "Endocarditis"
    },
    {
      "code": "20883",
      "display": "Fever of Unknown Origin (FUO)"
    },
    {
      "code": "20884",
      "display": "HIV"
    },
    {
      "code": "20885",
      "display": "Intra-Abdominal or Pelvic Infections"
    },
    {
      "code": "20886",
      "display": "Lung Infections"
    },
    {
      "code": "20887",
      "display": "Sexually Transmitted Infections (STIs)"
    },
    {
      "code": "20888",
      "display": "Skin and Soft Tissue Infections (SSTIs)"
    },
    {
      "code": "20889",
      "display": "Tick-borne Infections"
    },
    {
      "code": "20890",
      "display": "Tropical and Parasitic Diseases"
    },
    {
      "code": "20891",
      "display": "Tuberculosis (TB)"
    },
    {
      "code": "20892",
      "display": "Urinary Tract Infection (UTIs)"
    },
    {
      "code": "20893",
      "display": "Viral Hepatitis"
    },
    {
      "code": "20894",
      "display": "Osteomyelitis"
    },
    {
      "code": "20895",
      "display": "Prosthetic Joint Infection"
    },
    {
      "code": "20896",
      "display": "Septic Arthritis"
    },
    {
      "code": "20897",
      "display": "Spinal Infections"
    },
    {
      "code": "20898",
      "display": "HIV - New Diagnosis"
    },
    {
      "code": "20899",
      "display": "HIV - Ongoing Care"
    },
    {
      "code": "20900",
      "display": "PrEP (Pre-Exposure Prophylaxis)"
    },
    {
      "code": "20901",
      "display": "PEP (Post-Exposure Prophylaxis)"
    },
    {
      "code": "20903",
      "display": "Cellulitis"
    },
    {
      "code": "20904",
      "display": "Diabetic Foot Infection"
    },
    {
      "code": "20905",
      "display": "Malaria"
    },
    {
      "code": "20906",
      "display": "Active TB - Confirmed"
    },
    {
      "code": "20907",
      "display": "Active TB -� Suspected"
    },
    {
      "code": "20908",
      "display": "Latent TB Infection"
    },
    {
      "code": "20909",
      "display": "Active drug and/or alcohol addiction"
    },
    {
      "code": "20910",
      "display": "Active treatment for a major/life-threatening cancer (e.g. chemotherapy, radiation)"
    },
    {
      "code": "20911",
      "display": "Significant psychiatric illness that is inadequately treated"
    },
    {
      "code": "20912",
      "display": "Patient >18 years old"
    },
    {
      "code": "20913",
      "display": "Patient has an Ontario Health Card OR is a resident of Ontario and meets one of the following�"
    },
    {
      "code": "20915",
      "display": "Weight (kgs)"
    },
    {
      "code": "20916",
      "display": "Height (ft)"
    },
    {
      "code": "20917",
      "display": "Height (in)"
    },
    {
      "code": "20918",
      "display": "Weight (lbs)"
    },
    {
      "code": "20920",
      "display": "Previously had bariatric surgery"
    },
    {
      "code": "20921",
      "display": "Surgical complications"
    },
    {
      "code": "20922",
      "display": "Weight regain (>15% increase)"
    },
    {
      "code": "20923",
      "display": "Idiopathic intracranial hypertension"
    },
    {
      "code": "20924",
      "display": "Coronary heart disease"
    },
    {
      "code": "20925",
      "display": "Type 2 diabetes"
    },
    {
      "code": "20927",
      "display": "Diagnosed sleep apnea"
    },
    {
      "code": "20929",
      "display": "Renal disease"
    },
    {
      "code": "20930",
      "display": "Surgical Program"
    },
    {
      "code": "20931",
      "display": "Medical Program"
    },
    {
      "code": "20932",
      "display": "Pilot Metabolic Surgical Program at St. Joseph�s Healthcare Hamilton"
    },
    {
      "code": "20933",
      "display": "Optometrist / Ophthalmologist"
    },
    {
      "code": "20934",
      "display": "Primary Care"
    },
    {
      "code": "20935",
      "display": "Clinical Optometry/Ophthalmology Report attached"
    },
    {
      "code": "20936",
      "display": "Right Eye (OD)"
    },
    {
      "code": "20937",
      "display": "Left Eye (OS)"
    },
    {
      "code": "20938",
      "display": "Both Eyes (OU)"
    },
    {
      "code": "20939",
      "display": "Optometry / Ophthalmology report attached including Best Corrected Visual Acuity (BCVA) and Past Ocular History"
    },
    {
      "code": "20940",
      "display": "Right Eye"
    },
    {
      "code": "20941",
      "display": "Right Eye BCVA 20/"
    },
    {
      "code": "20942",
      "display": "Left Eye"
    },
    {
      "code": "20943",
      "display": "Left Eye BCVA 20/"
    },
    {
      "code": "20944",
      "display": "History of Ocular Pathologies"
    },
    {
      "code": "20945",
      "display": "History of Diabetes"
    },
    {
      "code": "20946",
      "display": "Right Eye (mmHg)"
    },
    {
      "code": "20947",
      "display": "Left Eye (mmHg)"
    },
    {
      "code": "20948",
      "display": "Does the patient wear contact lenses?"
    },
    {
      "code": "20949",
      "display": "Soft"
    },
    {
      "code": "20950",
      "display": "Rigid Gas Permeable"
    },
    {
      "code": "20951",
      "display": "Does the patient wear prism in their spectacles?"
    },
    {
      "code": "20952",
      "display": "Right Eye (prism)"
    },
    {
      "code": "20953",
      "display": "Left Eye (prism)"
    },
    {
      "code": "20954",
      "display": "Has the patient had previous corneal refractive surgery?"
    },
    {
      "code": "20955",
      "display": "LASIK"
    },
    {
      "code": "20956",
      "display": "PRK"
    },
    {
      "code": "20957",
      "display": "RK"
    },
    {
      "code": "20958",
      "display": "Has the patient had previous eye surgery or laser treatment?"
    },
    {
      "code": "20962",
      "display": "Adrenal Gland Disorders"
    },
    {
      "code": "20963",
      "display": "Diabetes"
    },
    {
      "code": "20964",
      "display": "Dyslipidemia"
    },
    {
      "code": "20965",
      "display": "Male Hypogonadism"
    },
    {
      "code": "20966",
      "display": "Menopause"
    },
    {
      "code": "20967",
      "display": "Oligomenorrhea / Amenorrhea"
    },
    {
      "code": "20968",
      "display": "Osteoporosis"
    },
    {
      "code": "20969",
      "display": "Parathyroid or Calcium Disorders"
    },
    {
      "code": "20970",
      "display": "Pituitary Gland Disorders"
    },
    {
      "code": "20972",
      "display": "Thyroid Disorders"
    },
    {
      "code": "20973",
      "display": "Transgender (Gender Affirming Hormone Therapy)"
    },
    {
      "code": "20974",
      "display": "Weight Management / Metabolic Disorders"
    },
    {
      "code": "20975",
      "display": "Type 1 Diabetes"
    },
    {
      "code": "20978",
      "display": "New"
    },
    {
      "code": "20979",
      "display": "<=6 months ago"
    },
    {
      "code": "20980",
      "display": "> 6 months ago"
    },
    {
      "code": "20977",
      "display": "Patient on insulin"
    },
    {
      "code": "20981",
      "display": "Chemotherapy - current or planned"
    },
    {
      "code": "20982",
      "display": "Diabetic Ketoacidosis - recent hospitalization"
    },
    {
      "code": "20983",
      "display": "Foot ulcer(s) - active or recurring"
    },
    {
      "code": "20984",
      "display": "Glucocorticoids - high doses with recent or anticipated initiation"
    },
    {
      "code": "20985",
      "display": "HbA1c >10%"
    },
    {
      "code": "20986",
      "display": "Hypoglycemia - severe and recent episode requiring assistance"
    },
    {
      "code": "20987",
      "display": "Myocardial infarction or Stroke - recent event with inadequate control"
    },
    {
      "code": "20988",
      "display": "Optimization required prior to procedure/surgery - Urgent"
    },
    {
      "code": "20989",
      "display": "Transplant within last 6 months"
    },
    {
      "code": "20990",
      "display": "HbA1C"
    },
    {
      "code": "20991",
      "display": "Triglycerides > 10 mmol/L"
    },
    {
      "code": "20992",
      "display": "Atypical femur fracture"
    },
    {
      "code": "20993",
      "display": "Fragility fracture - within last year"
    },
    {
      "code": "20994",
      "display": "Glucocorticoids - Currently on prolonged high-dose"
    },
    {
      "code": "20995",
      "display": "Glucocorticoids - Planned start of prolonged high-dose"
    },
    {
      "code": "20996",
      "display": "Acromegaly suspected (clinically or high IGF-1/growth hormone)"
    },
    {
      "code": "20997",
      "display": "Cushings disease suspected (clinically or lab testing)"
    },
    {
      "code": "20998",
      "display": "Dysfunction - decreased pituitary function (include labs)"
    },
    {
      "code": "20999",
      "display": "Prolactin > 200 ug/L"
    },
    {
      "code": "21000",
      "display": "Sellar lesion > 1 cm - confirmed on MRI or CT"
    },
    {
      "code": "21001",
      "display": "Visual fields compromised"
    },
    {
      "code": "21002",
      "display": "Hyperthyroidism"
    },
    {
      "code": "21003",
      "display": "Hypothyroidism"
    },
    {
      "code": "21004",
      "display": "Thyroid Nodule"
    },
    {
      "code": "21005",
      "display": "Thyroid Cancer"
    },
    {
      "code": "21006",
      "display": "TSH"
    },
    {
      "code": "21007",
      "display": "Site-Specific Suspicion of Cancer Presentations"
    },
    {
      "code": "21008",
      "display": "Non-Site Specific Suspicion of Cancer Presentations"
    },
    {
      "code": "21009",
      "display": "Breast"
    },
    {
      "code": "21010",
      "display": "Chest / Lung"
    },
    {
      "code": "21011",
      "display": "Genitourinary"
    },
    {
      "code": "21012",
      "display": "Gynecologic"
    },
    {
      "code": "21013",
      "display": "Head & Neck"
    },
    {
      "code": "21014",
      "display": "Hepatobiliary Pancreatic"
    },
    {
      "code": "21015",
      "display": "Luminal Upper and Lower Gastrointestinal"
    },
    {
      "code": "21016",
      "display": "Cutaneous Skin / Soft Tissue"
    },
    {
      "code": "21017",
      "display": "Suspicious imaging for malignancy"
    },
    {
      "code": "21018",
      "display": "Constitutional"
    },
    {
      "code": "21019",
      "display": "Hematologic"
    },
    {
      "code": "21020",
      "display": "Unintentional, unexplained =10% weight loss (6�12 months, or shorter if severe)"
    },
    {
      "code": "21021",
      "display": "Persistent, unexplained fatigue, functionally impairing and not relieved by rest"
    },
    {
      "code": "21022",
      "display": "Bone pain - long bone or spine"
    },
    {
      "code": "21023",
      "display": "Persistent or unexplained abdominal pain"
    },
    {
      "code": "21024",
      "display": "Persistent or unexplained pelvic pain"
    },
    {
      "code": "21025",
      "display": "Subacute or progressive neurologic symptoms"
    },
    {
      "code": "21026",
      "display": "Leukemia-pattern blood abnormalities"
    },
    {
      "code": "21027",
      "display": "Lymphoma-pattern presentation"
    },
    {
      "code": "21028",
      "display": "MDS/MPN/Myeloma-pattern presentation"
    },
    {
      "code": "21029",
      "display": "Abnormal Imaging"
    },
    {
      "code": "21036",
      "display": "Medical Issue Affecting Pregnancy"
    },
    {
      "code": "21037",
      "display": "Perioperative Assessment"
    },
    {
      "code": "21039",
      "display": "Thyroid"
    },
    {
      "code": "21040",
      "display": "Unexplained Weight Loss"
    },
    {
      "code": "21041",
      "display": "Anemia"
    },
    {
      "code": "21042",
      "display": "Arrhythmia"
    },
    {
      "code": "21046",
      "display": "Preconception"
    },
    {
      "code": "21047",
      "display": "Thrombocytopenia"
    },
    {
      "code": "21049",
      "display": "Venous Thromboembolism"
    },
    {
      "code": "21050",
      "display": "Behavioural"
    },
    {
      "code": "21051",
      "display": "Cardiac"
    },
    {
      "code": "21052",
      "display": "Developmental / Growth"
    },
    {
      "code": "21053",
      "display": "Dermatologic"
    },
    {
      "code": "21054",
      "display": "Endocrine"
    },
    {
      "code": "21055",
      "display": "Gastrointestinal"
    },
    {
      "code": "21056",
      "display": "Genetic"
    },
    {
      "code": "21058",
      "display": "Musculoskeletal / Rheumatologic"
    },
    {
      "code": "21059",
      "display": "Neonatal"
    },
    {
      "code": "21060",
      "display": "Mental Health"
    },
    {
      "code": "21061",
      "display": "Neurologic"
    },
    {
      "code": "21062",
      "display": "Renal"
    },
    {
      "code": "21063",
      "display": "Respiratory"
    },
    {
      "code": "21064",
      "display": "Attention Deficit Hyperactivity Disorder (ADHD)"
    },
    {
      "code": "21065",
      "display": "Autism Spectrum Disorder (ASD)"
    },
    {
      "code": "21067",
      "display": "Palpitations"
    },
    {
      "code": "21069",
      "display": "Fine Motor Delay"
    },
    {
      "code": "21070",
      "display": "Gross Motor Delay"
    },
    {
      "code": "21071",
      "display": "Growth Concerns"
    },
    {
      "code": "21072",
      "display": "Learning Disability / Learning Problem"
    },
    {
      "code": "21073",
      "display": "Speech or Language Disorder"
    },
    {
      "code": "21074",
      "display": "Failure to Thrive"
    },
    {
      "code": "21075",
      "display": "Atopic Dermatitis"
    },
    {
      "code": "21076",
      "display": "Birth Mark"
    },
    {
      "code": "21077",
      "display": "Hemangioma"
    },
    {
      "code": "21078",
      "display": "Rash"
    },
    {
      "code": "21080",
      "display": "Gender Dysphoria"
    },
    {
      "code": "21081",
      "display": "Menstrual Irregularities"
    },
    {
      "code": "21082",
      "display": "Obesity"
    },
    {
      "code": "21083",
      "display": "Premature or Delayed Puberty"
    },
    {
      "code": "21084",
      "display": "Short Stature"
    },
    {
      "code": "21085",
      "display": "Thyroid Dysfunction"
    },
    {
      "code": "21086",
      "display": "Abdominal Pain"
    },
    {
      "code": "21089",
      "display": "Encopresis"
    },
    {
      "code": "21090",
      "display": "GERD"
    },
    {
      "code": "21091",
      "display": "Dysmorphic / Syndromic"
    },
    {
      "code": "21092",
      "display": "Family History of Known Genetic Disorder"
    },
    {
      "code": "21093",
      "display": "Trisomy 21"
    },
    {
      "code": "21096",
      "display": "Neutropenia"
    },
    {
      "code": "21098",
      "display": "Gait Concerns"
    },
    {
      "code": "21099",
      "display": "Joint / Bone Pain"
    },
    {
      "code": "21100",
      "display": "Joint Swelling"
    },
    {
      "code": "21101",
      "display": "Scoliosis"
    },
    {
      "code": "21102",
      "display": "Feeding Difficulties"
    },
    {
      "code": "21103",
      "display": "Hyperbilirubinemia"
    },
    {
      "code": "21104",
      "display": "Low Birth Weight"
    },
    {
      "code": "21105",
      "display": "Neonatal Seizures"
    },
    {
      "code": "21106",
      "display": "Prematurity"
    },
    {
      "code": "21107",
      "display": "Anxiety"
    },
    {
      "code": "21108",
      "display": "Depression"
    },
    {
      "code": "21109",
      "display": "Epilepsy"
    },
    {
      "code": "21110",
      "display": "Febrile Seizure(s)"
    },
    {
      "code": "21111",
      "display": "Headaches"
    },
    {
      "code": "21112",
      "display": "Tics"
    },
    {
      "code": "21113",
      "display": "Enuresis"
    },
    {
      "code": "21115",
      "display": "UTI(s)"
    },
    {
      "code": "21117",
      "display": "Persistent Cough"
    },
    {
      "code": "21118",
      "display": "Upper and Lower Respiratory Issues"
    },
    {
      "code": "21119",
      "display": "Abdominal Lesion / Mass"
    },
    {
      "code": "21120",
      "display": "Abdominal Pain NYD - Chronic"
    },
    {
      "code": "21121",
      "display": "Anorectal / Perianal Conditions"
    },
    {
      "code": "21122",
      "display": "Breast Conditions"
    },
    {
      "code": "21123",
      "display": "Colonoscopy - Screening / Surveillance"
    },
    {
      "code": "21124",
      "display": "Colorectal Conditions"
    },
    {
      "code": "21126",
      "display": "Hepatobiliary & Pancreatic Conditions"
    },
    {
      "code": "21127",
      "display": "Hernias"
    },
    {
      "code": "21128",
      "display": "Rectal Bleeding NYD"
    },
    {
      "code": "21129",
      "display": "Skin & Soft-Tissue Lesions"
    },
    {
      "code": "21130",
      "display": "Upper GI Tract Disorder"
    },
    {
      "code": "21131",
      "display": "Anal Region Disorders (e.g. fissures, fistulas, hemorrhoids)"
    },
    {
      "code": "21132",
      "display": "Fecal Incontinence"
    },
    {
      "code": "21133",
      "display": "Pilonidal Disease"
    },
    {
      "code": "21134",
      "display": "Rectal Prolapse"
    },
    {
      "code": "21135",
      "display": "Breast Lump"
    },
    {
      "code": "21138",
      "display": "Screening"
    },
    {
      "code": "21139",
      "display": "Surveillance"
    },
    {
      "code": "21140",
      "display": "Colorectal Lesion / Mass (e.g. polyp, cancer)"
    },
    {
      "code": "21141",
      "display": "Diverticulitis"
    },
    {
      "code": "21142",
      "display": "Inflammatory Bowel Disease"
    },
    {
      "code": "21144",
      "display": "Parathyroid Disease"
    },
    {
      "code": "21145",
      "display": "Thyroid Mass / Enlargement"
    },
    {
      "code": "21146",
      "display": "Gallbladder / Gallstone Disease"
    },
    {
      "code": "21147",
      "display": "Gallbladder Polyp / Mass"
    },
    {
      "code": "21148",
      "display": "Liver Lesion / Mass"
    },
    {
      "code": "21149",
      "display": "Pancreatic Lesion / Mass"
    },
    {
      "code": "21150",
      "display": "Inguinal Hernia"
    },
    {
      "code": "21151",
      "display": "Umbilical / Epigastric Hernia"
    },
    {
      "code": "21152",
      "display": "Ventral / Incisional Hernia"
    },
    {
      "code": "21153",
      "display": "Benign Lesion (e.g. lipoma, cyst)"
    },
    {
      "code": "21154",
      "display": "Lymph Node"
    },
    {
      "code": "21156",
      "display": "First-degree relative(s) with colorectal cancer"
    },
    {
      "code": "21157",
      "display": "Hereditary cancer syndrome"
    },
    {
      "code": "21158",
      "display": "First-degree relative(s) with documented advanced polyps before age 60"
    },
    {
      "code": "21159",
      "display": "Frailty or Health / Social Complexity"
    },
    {
      "code": "21160",
      "display": "Goals of Care and Future Planning"
    },
    {
      "code": "21161",
      "display": "Medication Review / Advice"
    },
    {
      "code": "21162",
      "display": "Mind or Mood"
    },
    {
      "code": "21163",
      "display": "Mobility"
    },
    {
      "code": "21164",
      "display": "Caregiver Burden"
    },
    {
      "code": "21165",
      "display": "Complex Psychosocial / Economic"
    },
    {
      "code": "21166",
      "display": "Frailty"
    },
    {
      "code": "21167",
      "display": "Generalized Functional Decline"
    },
    {
      "code": "21168",
      "display": "Multi-morbidity"
    },
    {
      "code": "21172",
      "display": "Cognitive Impairment"
    },
    {
      "code": "21173",
      "display": "Mood Disorder"
    },
    {
      "code": "21174",
      "display": "Responsive Behaviours (e.g. aggression, wandering etc...)"
    },
    {
      "code": "21175",
      "display": "Psychotic Symptoms (e.g. hallucinations, delusions, etc...)"
    },
    {
      "code": "21176",
      "display": "Impaired Gait / Balance"
    },
    {
      "code": "21177",
      "display": "Falls"
    },
    {
      "code": "21198",
      "display": "General Neurosurgery"
    },
    {
      "code": "21199",
      "display": "Cranial / Brain & Skull Lesions"
    },
    {
      "code": "21201",
      "display": "Hydrocephalus / Cerebrospinal Fluid (CSF)"
    },
    {
      "code": "21202",
      "display": "Neurovascular"
    },
    {
      "code": "21205",
      "display": "Cranial Arachnoid Cyst"
    },
    {
      "code": "21206",
      "display": "Chiari Malformation"
    },
    {
      "code": "21207",
      "display": "Microvascular Decompression - Trigeminal Neuralgia, Hemifacial Spasm"
    },
    {
      "code": "21208",
      "display": "Neurosurgery Spine (intradural pathology) - Syrinx, Arachnoid Cyst, Tumour, Tethered Cord, etc."
    },
    {
      "code": "21209",
      "display": "Subdural Hematoma - Chronic"
    },
    {
      "code": "21210",
      "display": "Brain Tumour - Primary"
    },
    {
      "code": "21211",
      "display": "Brain Tumour - Metastatic"
    },
    {
      "code": "21212",
      "display": "Meningioma"
    },
    {
      "code": "21213",
      "display": "Pituitary / Sellar Lesion"
    },
    {
      "code": "21214",
      "display": "Skull Base / Cranial Nerve Tumour"
    },
    {
      "code": "21215",
      "display": "Epilepsy Surgery Assessment"
    },
    {
      "code": "21216",
      "display": "Neuromodulation for Pain"
    },
    {
      "code": "21217",
      "display": "Parkinson's - Deep Brain Stimulation Surgical Assessment"
    },
    {
      "code": "21218",
      "display": "Other Movement Disorder - Deep Brain Stimulation Surgical Assessment"
    },
    {
      "code": "21219",
      "display": "CSF Shunt Assessment (Insertion / Revision / Removal)"
    },
    {
      "code": "21220",
      "display": "Hydrocephalus - Normal Pressure (NPH)"
    },
    {
      "code": "21221",
      "display": "Hydrocephalus - Other (non-NPH)"
    },
    {
      "code": "21222",
      "display": "Arteriovenous Malformation (AVM) / Dural AV Fistula"
    },
    {
      "code": "21223",
      "display": "Brain Aneurysm - Unruptured"
    },
    {
      "code": "21224",
      "display": "Carotid Stenosis"
    },
    {
      "code": "21225",
      "display": "Cavernous Malformation"
    },
    {
      "code": "21226",
      "display": "Brachial Plexus Injury/Lesion"
    },
    {
      "code": "21229",
      "display": "Ulnar Nerve Entrapment"
    },
    {
      "code": "21230",
      "display": "Other Focal Nerve Entrapment (radial, peroneal, etc.)"
    },
    {
      "code": "21231",
      "display": "Cervical"
    },
    {
      "code": "21232",
      "display": "Thoracic"
    },
    {
      "code": "21233",
      "display": "Lumbar"
    },
    {
      "code": "21234",
      "display": "Congenital Hemolytic Anemia"
    },
    {
      "code": "21236",
      "display": "Hereditary Spherocytosis"
    },
    {
      "code": "21238",
      "display": "Thalassemia"
    },
    {
      "code": "21239",
      "display": "Uncomplicated Hemoglobinopathy Trait (Sickle Trait, Thalassemia Trait)"
    },
    {
      "code": "21240",
      "display": "Aneurysm / Dissection - Asymptomatic"
    },
    {
      "code": "21241",
      "display": "Carotid Stenosis - Asymptomatic"
    },
    {
      "code": "21242",
      "display": "Diabetic Foot Ulcers"
    },
    {
      "code": "21243",
      "display": "Peripheral Arterial Disease"
    },
    {
      "code": "21244",
      "display": "Venous Disease"
    },
    {
      "code": "21245",
      "display": "Abdominal Aortic Aneurysm (AAA)"
    },
    {
      "code": "21246",
      "display": "Descending Thoracic Aortic Aneurysm, Pathology or Dissection"
    },
    {
      "code": "21247",
      "display": "Other Aneurysm (e.g. Popliteal, Visceral, Renal)"
    },
    {
      "code": "21248",
      "display": "With high risk features (e.g. ulcerated / irregular plaque, plaque hemorrhage, contralateral ICA occlusion, progressive stenosis, young patients)"
    },
    {
      "code": "21249",
      "display": "Symptoms within 2 weeks to 6 months and more than 50% ICA stenosis"
    },
    {
      "code": "21250",
      "display": "Without high risk features, more than 50% ICA stenosis and no symptoms within 6 months"
    },
    {
      "code": "21251",
      "display": "Ulcer"
    },
    {
      "code": "21252",
      "display": "Active infection"
    },
    {
      "code": "21254",
      "display": "Asymptomatic"
    },
    {
      "code": "21255",
      "display": "Claudication"
    },
    {
      "code": "21256",
      "display": "Chronic Limb-Threatening Ischemia (e.g. rest pain, tissue loss)"
    },
    {
      "code": "21257",
      "display": "Upper Extremity Disease"
    },
    {
      "code": "21258",
      "display": "Varicose Veins with complication"
    },
    {
      "code": "21259",
      "display": "Varicose Veins without complication"
    },
    {
      "code": "21260",
      "display": "Upper Extremity Venous Disease"
    },
    {
      "code": "21261",
      "display": "Currently Pregnant"
    },
    {
      "code": "21262",
      "display": "Currently Pregnant or <12 Months Postpartum"
    },
    {
      "code": "21264",
      "display": "Second Opinion"
    },
    {
      "code": "21265",
      "display": "Recent Hospitalization or ER Visit for this issue"
    },
    {
      "code": "21266",
      "display": "< 1 Year Old"
    },
    {
      "code": "21267",
      "display": "Referral for child or youth (<18 years old)"
    },
    {
      "code": "21268",
      "display": "Preoperative Management"
    },
    {
      "code": "21269",
      "display": "Cognitively impaired"
    },
    {
      "code": "21270",
      "display": "Falls risk"
    },
    {
      "code": "21271",
      "display": "Hearing impaired"
    },
    {
      "code": "21272",
      "display": "Patient requires lift"
    },
    {
      "code": "21273",
      "display": "Vision impaired"
    },
    {
      "code": "21274",
      "display": "Wheelchair"
    },
    {
      "code": "21275",
      "display": "Allied Health Professional"
    },
    {
      "code": "21276",
      "display": "Family Physician",
      "designation": [
        {
          "language": "fr",
          "value": "Médecin de famille"
        }
      ]
    },
    {
      "code": "21277",
      "display": "Physician Assistant"
    },
    {
      "code": "21278",
      "display": "Medical Student"
    },
    {
      "code": "21279",
      "display": "Nurse"
    },
    {
      "code": "21280",
      "display": "Nurse Practitioner"
    },
    {
      "code": "21281",
      "display": "Resident"
    },
    {
      "code": "21282",
      "display": "Specialist"
    },
    {
      "code": "21283",
      "display": "No known kidney issues",
      "designation": [
        {
          "language": "fr",
          "value": "Aucun problème rénal connu"
        }
      ]
    },
    {
      "code": "21284",
      "display": "Yes, patient has impaired renal function or a history of renal transplant"
    },
    {
      "code": "21285",
      "display": "eGFR result"
    },
    {
      "code": "21286",
      "display": "Has diabetes"
    },
    {
      "code": "21287",
      "display": "On dialysis"
    },
    {
      "code": "21288",
      "display": "Known hypersensitivity to contrast agents"
    },
    {
      "code": "21289",
      "display": "History of reaction before the year 2000"
    },
    {
      "code": "21291",
      "display": "Estimated Date of Delivery"
    },
    {
      "code": "21292",
      "display": "Last Menstrual Period"
    },
    {
      "code": "21293",
      "display": "Currently breastfeeding",
      "designation": [
        {
          "language": "fr",
          "value": "Allaite actuellement"
        }
      ]
    },
    {
      "code": "21294",
      "display": "Claustrophobia"
    },
    {
      "code": "21295",
      "display": "Require general anesthesia"
    },
    {
      "code": "21296",
      "display": "Has metal fragments in eye(s)/body"
    },
    {
      "code": "21297",
      "display": "Has active electronic implants (e.g. Cardiac Implantable Electronic Device, Neurostimulator, Cochlear Implant, Medication Pump, etc.) or retained parts (e.g. leads, etc.):"
    },
    {
      "code": "21298",
      "display": "Has other metal containing devices (e.g. Aneurysm Clip, IUD, Tissue Expander, Shunt, Stent, Coil, Traction Device, Glucose Monitor, etc.), metal foreign bodies (Shrapnel, Bullets, Subdermal Piercings, Etc), or orthopedic device:"
    },
    {
      "code": "21299",
      "display": "CIED"
    },
    {
      "code": "21300",
      "display": "Neurostimulator"
    },
    {
      "code": "21301",
      "display": "Cochlear Implant"
    },
    {
      "code": "21302",
      "display": "Medication Pump"
    },
    {
      "code": "21303",
      "display": "Aneurysm Clip"
    },
    {
      "code": "21304",
      "display": "Coil"
    },
    {
      "code": "21305",
      "display": "Glucose Monitor"
    },
    {
      "code": "21306",
      "display": "Heart Valve"
    },
    {
      "code": "21307",
      "display": "Copper or Stainless Steel IUD"
    },
    {
      "code": "21308",
      "display": "Orthopedic Devices"
    },
    {
      "code": "21309",
      "display": "Pessary"
    },
    {
      "code": "21310",
      "display": "Prosthesis"
    },
    {
      "code": "21311",
      "display": "Shunt"
    },
    {
      "code": "21312",
      "display": "Stent"
    },
    {
      "code": "21313",
      "display": "Subdermal Piercings"
    },
    {
      "code": "21314",
      "display": "Tissue Expander"
    },
    {
      "code": "21315",
      "display": "Traction Device"
    },
    {
      "code": "21316",
      "display": "Patient has impaired renal function or a history of renal transplant"
    },
    {
      "code": "21317",
      "display": "She/Her"
    },
    {
      "code": "21318",
      "display": "He/Him"
    },
    {
      "code": "21319",
      "display": "They/Them"
    },
    {
      "code": "21320",
      "display": "Immunocompromised"
    },
    {
      "code": "21321",
      "display": "Left"
    },
    {
      "code": "21322",
      "display": "Right"
    },
    {
      "code": "21323",
      "display": "Bilateral",
      "designation": [
        {
          "language": "fr",
          "value": "Bilatéral"
        }
      ]
    },
    {
      "code": "21324",
      "display": "Patient cannot provide reliable medical history or provide consent to contrast injections (where applicable)"
    },
    {
      "code": "21325",
      "display": "Abnormal Lab Finding"
    },
    {
      "code": "21326",
      "display": "Vomiting"
    },
    {
      "code": "21327",
      "display": "Weight Loss"
    },
    {
      "code": "21328",
      "display": "Eating Concerns"
    },
    {
      "code": "21329",
      "display": "Custody Considerations"
    },
    {
      "code": "21330",
      "display": "Child Welfare Agency Involvement (e.g., Children's Aid Society)"
    },
    {
      "code": "21331",
      "display": "Suspected Malignancy"
    },
    {
      "code": "21332",
      "display": "Confirmed Malignancy"
    },
    {
      "code": "21333",
      "display": "Endocrine Conditions"
    },
    {
      "code": "21344",
      "display": "Breast Inflammation / Abscess"
    },
    {
      "code": "21345",
      "display": "Imaging Abnormality"
    },
    {
      "code": "21346",
      "display": "Wound Management"
    },
    {
      "code": "21347",
      "display": "G6PD Deficiency"
    },
    {
      "code": "21348",
      "display": "PK Deficiency"
    },
    {
      "code": "21349",
      "display": "HbSS"
    },
    {
      "code": "21350",
      "display": "HbSC"
    },
    {
      "code": "21351",
      "display": "HbS/�-thalassemia"
    },
    {
      "code": "21352",
      "display": "Transfusion-Dependent Thalassemia"
    },
    {
      "code": "21353",
      "display": "Non-Transfusion-Dependent Thalassemia"
    },
    {
      "code": "21354",
      "display": "Movement Disorder"
    },
    {
      "code": "21355",
      "display": "Unintentional Weight Change / Nutritional Concerns"
    },
    {
      "code": "21356",
      "display": "Sleep Concerns"
    },
    {
      "code": "21357",
      "display": "Arrived in Canada in past 3-6 months"
    },
    {
      "code": "21358",
      "display": "Recent or Ongoing Complications"
    },
    {
      "code": "21359",
      "display": "Referred from Sickle Cell Comprehensive Care Clinic"
    },
    {
      "code": "21360",
      "display": "Requires ongoing Red Blood Cell transfusion support"
    },
    {
      "code": "21361",
      "display": "Transfer of care"
    },
    {
      "code": "21362",
      "display": "Non-Invasive Vascular Testing"
    },
    {
      "code": "21363",
      "display": "Vascular Consultation"
    },
    {
      "code": "21364",
      "display": "Nerve Root Impingement / Radiculopathy Present"
    },
    {
      "code": "21365",
      "display": "Functional Neurosurgery - Surgical Assessment (Epilepsy, Movement, Pain)"
    },
    {
      "code": "21366",
      "display": "Adrenals"
    },
    {
      "code": "21367",
      "display": "Bone"
    },
    {
      "code": "21368",
      "display": "Kidneys"
    },
    {
      "code": "21369",
      "display": "Liver"
    },
    {
      "code": "21370",
      "display": "Lung"
    },
    {
      "code": "21371",
      "display": "Lymph nodes"
    },
    {
      "code": "21372",
      "display": "Mediastinal mass"
    },
    {
      "code": "21373",
      "display": "Pancreas"
    },
    {
      "code": "21374",
      "display": "Pelvis"
    },
    {
      "code": "21375",
      "display": "Thoracic Outlet Syndrome"
    },
    {
      "code": "21376",
      "display": "Arterial"
    },
    {
      "code": "21377",
      "display": "Venous"
    },
    {
      "code": "21378",
      "display": "Arm"
    },
    {
      "code": "21379",
      "display": "Leg"
    },
    {
      "code": "21380",
      "display": "Ankle brachial index (screening)"
    },
    {
      "code": "21381",
      "display": "Fasting"
    },
    {
      "code": "21382",
      "display": "Post-prandial"
    },
    {
      "code": "21383",
      "display": "Existing PICC line"
    },
    {
      "code": "21384",
      "display": "Existing Port-a-Cath"
    },
    {
      "code": "21385",
      "display": "What is the patient's current resting heart rate (bpm)?"
    },
    {
      "code": "21386",
      "display": "Known contraindications to Nitroglycerin:"
    },
    {
      "code": "21387",
      "display": "Is the patient currently on beta-blockers?"
    },
    {
      "code": "21388",
      "display": "Severe/critical aortic stenosis"
    },
    {
      "code": "21389",
      "display": "Severe symptomatic aortic insufficiency"
    },
    {
      "code": "21390",
      "display": "Decompensated congestive heart failure"
    },
    {
      "code": "21391",
      "display": "Allergy to Beta-blockers"
    },
    {
      "code": "21392",
      "display": "Prior hospitalization for lung disease"
    },
    {
      "code": "21393",
      "display": "Active bronchospasm"
    },
    {
      "code": "21394",
      "display": "2nd or 3rd degree heart block, or 1st degree with PR>0.42s"
    },
    {
      "code": "21395",
      "display": "Will the patient be prescribed a beta-blocker?"
    },
    {
      "code": "21396",
      "display": "Spinal Cord Compression Present"
    },
    {
      "code": "21397",
      "display": "Date of First Suspicion of Cancer"
    },
    {
      "code": "21398",
      "display": "Abdomen Pelvis Angiography"
    },
    {
      "code": "21399",
      "display": "None of the above"
    },
    {
      "code": "21400",
      "display": "Unsure/Unknown"
    },
    {
      "code": "21401",
      "display": "Intersex"
    },
    {
      "code": "21402",
      "display": "Other"
    },
    {
      "code": "21403",
      "display": "Translator Required"
    },
    {
      "code": "21404",
      "display": "Preferred Name"
    },
    {
      "code": "21405",
      "display": "Voicemails acceptable"
    },
    {
      "code": "21406",
      "display": "Alternate contact"
    },
    {
      "code": "21407",
      "display": "Yes"
    },
    {
      "code": "21408",
      "display": "No"
    },
    {
      "code": "21409",
      "display": "Unsafe contact persons (do not speak with)"
    },
    {
      "code": "21410",
      "display": "Only speak with patient directly"
    },
    {
      "code": "21411",
      "display": "Accessibility concerns or disability"
    },
    {
      "code": "21412",
      "display": "Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)"
    },
    {
      "code": "21413",
      "display": "Send copies of reports to additional providers"
    },
    {
      "code": "21414",
      "display": "This is the Primary Care Provider"
    },
    {
      "code": "21415",
      "display": "CPP attached separately (if not entered below)"
    },
    {
      "code": "21416",
      "display": "Preferred consultant or location"
    },
    {
      "code": "21417",
      "display": "Patient willing to travel for shorter wait time"
    },
    {
      "code": "21418",
      "display": "Personal Health Information that is medically relevant has not been disclosed at the request of the patient."
    },
    {
      "code": "21419",
      "display": "OHIP"
    },
    {
      "code": "21420",
      "display": "WSIB Case"
    },
    {
      "code": "21421",
      "display": "DND"
    },
    {
      "code": "21422",
      "display": "IFH"
    },
    {
      "code": "21423",
      "display": "RAMQ"
    }
  ]
}