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

First Dose Parenteral Medication Screener – South East

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

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.

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

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.

Home and Community Care Support Services South East Medical Order Form

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

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

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