Additional Referral Information

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The following sets of fields are optional and chosen by selecting yes to each of the following questions:

  • Family Doctor Information
  • Legal Representation
  • Employer Information
  • Interpreter Required
  • Transportation Required

Family Doctor Fields

The following fields are specific to the associated family doctor:

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Legal Representation Fields

The following fields are specific to the associated legal representation of the claimant:

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Employee Information Fields

The following fields are specific to the employment of the claimant:

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Claimant Special Needs

The following fields describe any special needs that the claimant may have for interpreter or transportation:

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Languages

The following languages are displayed in the language list:

  • English
  • Afrikaans
  • Akan
  • Albanian
  • ASL
  • Amharic
  • Arabic
  • Armenian
  • Assyrian
  • Ashanti
  • Azerbaijani
  • Bengali
  • Bosnian
  • Bulgarian
  • Burmese
  • Cambodian
  • Cantonese
  • Catalan
  • Chinese
  • Creole
  • Croatian
  • Czech
  • Danish
  • Dari
  • Dinka
  • Dutch
  • Estonian
  • Ewe
  • Fanti
  • Farsi
  • Finnish
  • Flemish
  • Frafra
  • French
  • Fuchow
  • Fukienese
  • Ga
  • German
  • Greek
  • Gujarati
  • Hakka
  • Hausa
  • Hebrew
  • Hindi
  • Hungarian
  • Ibo
  • Ilocano
  • Indonesian
  • Italian
  • Japanese
  • Katchi
  • Kermanji
  • Korean
  • Kurdish
  • Kwa
  • Lao
  • Latin
  • Latvian
  • Lithuanian
  • Macedonian
  • Malay
  • Malayalam
  • Maltese
  • Mandarin
  • Marathi
  • Norwegian
  • Pilipino
  • Persian
  • Polish
  • Portuguese
  • Punjabi
  • Pushtu
  • Romanian
  • Russian
  • Serbian
  • Shanghai
  • Singhalese
  • Slovak
  • Slovenian
  • Somali
  • Spanish
  • Swahili
  • Swedish
  • Tagalog
  • Taiwanese
  • Tamil
  • Telugu
  • Thai
  • Tigrinya
  • Toisan
  • Turkish
  • Twi
  • Ukrainian
  • Urdu
  • Vietnamese
  • Yiddish
  • Yoruba
  • Zulu

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