Steps for sending MSP Covered Medical Services Referrals

For doctors:

  1. Download the above referral form, and fax it to 604 566 9102

  2. When we receive the referral form, we will send your office an acceptance letter and contact your patient with the appointment date and time.

  3. Mandatory information to include in the referral:

    • The patient’s email address and cell phone number are mandatory as these are our primary methods of communication. If the patient does not have an email, please have them complete the Proxy Access Consent form and fax it back along with the referral

    • Attach key consults and imaging reports within the last two years

  • Referring doctor sends a no-charge referral 3333 to MSP under Dr. Brenda Lau (#26194)

  • Note: Dr. Lau receives all referrals on behalf of all the CHANGEpain physicians.

4. Important: Please provide all the mandatory information on the referral form, else the referral will be rejected.


Medical Services Acceptance Criteria

Urgent Referrals (Additional to requirements for Non- Urgent Referrals)

  • Medically stable Cancer patients requiring urgent procedures

  • Urgent multidisciplinary team assessment (private pay only)

  • Patients with < 3 months onset radicular pain (radiologically plus clinically abnormal findings)

  • Complex regional pain syndrome or Reflex Sympathetic Dystrophy (RSD)

  • Non-responsive Depression (ketamine infusion)

  • Severe neuropathic pain (lidocaine or ketamine infusion therapy)

Non- Urgent Referrals

  • The patient must have a family physician or a regular walk-in clinic that will provide follow-up care and medication renewal.

  • Patient is unresponsive to conventional treatment.

  • Patient and/or caregiver are cognitively capable and willing to participate with suggested regimen of therapy.

  • Patient is able to communicate in English or able to bring an interpreter to all the appointments

  • Patient requires perioperative optimization (SPOC)

  • Referring Physician(s) agrees:

    • to participate with a suggested regimen of therapy

    • to continue to be their primary care provider. CHANGEpain does not take over primary care of the patient or ongoing medication prescription

    • To order appropriate initial investigations ruling out red flag conditions

    • To send completed results


Medical Services Rejection Criteria

  • Patients without Primary Care Physician or Walk-In clinics able to provide ongoing care.

  • Patient is medically unstable requiring inpatient care and monitoring.

  • Patient has an undertreated ongoing infection source.

  • Patient has untreated/uncontrolled addiction to controlled substances or mental illness, leaving them unable to comply with pain management recommendations.

  • Active WorkSafe BC patients, unless Worksafe BC has confirmed whether or not they will cover CHANGEpain services.

  • Patients who are 17 and under at the time the referral is sent

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