South East area

Continuous Ambulatory Delivery Device Patient Controlled Analgesia Prescription Order.
Fax completed CADD Prescription/Order forms to Ontario Health atHome at 1-866-839-7299

Patients enrolled in the COVID-19 Remote Monitoring Program use an app on their smartphone to report their symptoms to their nurse.

First Dose Parenteral Medication Screener – South East

Formulaire de demande pour la divulgation de renseignements personnels. En vertu de la Loi de 2004 sur la protection des renseignements personnels sur la santé Veuillez

To order care relating to Home Parenteral Nutrition in the South East. NOTE: Two (2) business days notice required

Referral form for administering COVID-19 antivirals in South East community nursing clinics.

For help to complete the form, please call Ontario Health atHome’s central access team at 1-800-869-8828 ext. 4003.

NOTE: Referral processing cannot be initiated unless page 1 of form is complete. Referring physician will be notified re missing & required information as soon as noted, in order to prevent delay in service arrangements.

You may choose up to five (5) long-term care homes.

Formulaire de choix de foyer de soins de longue durée. Vous pouvez choisir jusqu’à cinq (5) foyers de soins de longue durée.

South East Medical Assistance in Dying Assessment Record, Please ensure form is completed and uploaded to patient’s CHRIS file.

By completing this form, the prescriber confirms that all safeguards have been met for the patient to be eligible to receive MAID.
Please ensure form is completed for accuracy. Once completed fax to 1-888-334-6559.

South East Medical Assistance in Dying Procedural Record

Home and Community Care Support Services South East Medical Order Form

Mental Health & Addiction (MHAN) Nurse Referral. Please fax to: 1-613-650-2992

Fax: 613-650-2996
*Hospital: Use hospital Ontario Health atHome fax number

Note: NPWT will continue to be assessed in the community, and settings may be reviewed based on exudate and patient tolerance. Continuation of NPWT is dependent on wound healing goals being met. Maximum treatment time for NPWT is 8 weeks.

Palliative Care SBAR Communication Tool for Nurses in the South East

Ontario Health atHome – South East referrals from hospital

Request for Release of Personal Health Information under the Personal Health Information Protection Act, 2004

Ontario Health atHome, South East area service request/referral form

Trousse de gestion des symptômes pour les soins en fin de vie – Formulaire de commande

Timing and placement of the Symptom Response Kit requires careful consideration with a goal of avoiding emergency room visit or hospital admission.