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Symptom Response Kit for End-of-Life Order Form Please fax your completed form to the appropriate Ontario Health atHome branch: Central East: 1-855-352-2555 Champlain: 1-800-373-4945 South East: 1-866-839-7299 Timing and placement of the Symptom Response Kit (SRK) requires careful consideration (i.e. prognosis is less than six months; patient expected to deteriorate quickly) with goal of avoiding emergency room visit or hospital admission. Medications in the SRK will expire; therefore, will need to be reviewed and reordered by the physician/Nurse Practitioner (NP) if it remains appropriate. Consider reviewing goals of care and expected home death protocols.