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Guidelines & Advice
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Lung Screening Referral Form & Criteria

This page tells primary care providers how to refer patients at high risk of getting lung cancer to an Ontario Lung Screening Program site hospital to determine if they are eligible for screening.

Referral Inclusion Criteria

Current and former smokers ages 55 to 74 may be referred to the program if they have smoked cigarettes daily for at least 20 years (not necessarily 20 years in a row, which means there could be times when they did not smoke).

Not everyone who meets the referral inclusion criteria will be eligible for lung cancer screening in the program.

Determining Eligibility Is a 2-Step Process

Only people who meet the criteria in steps 1 and 2 will be eligible to get screened for lung cancer through the program.

  • Step 1: Primary care providers refer patients who meet the referral inclusion criteria to an Ontario Lung Screening Program site hospital.
    People can also contact the Ontario Lung Screening Program site hospital on their own to have their age and smoking history criteria assessed.
  • Step 2: An Ontario Lung Screening Program site hospital screening navigator conducts a risk assessment with anyone who meets the age and smoking history criteria in step 1. The results of the risk assessment in step 2 determine whether someone is eligible to get screened for lung cancer through the program.

When primary care providers refer their patients to an Ontario Lung Screening Program site hospital in step 1, they must complete the program’s referral form to authorize the use of low-dose computed tomography in case their patient is found to be eligible in step 2.

People who contact an Ontario Lung Screening Program site hospital directly and are found to be eligible in step 2 will still need a referral from a primary care provider to participate in lung cancer screening through the program.

Download the referral form from the side bar.

To find participating hospitals, see Ontario Lung Screening Program Locations.

For details about the program, see Ontario Lung Screening Program.