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Need Mental Health and Addictions Support?

Our specialized nurses work in the community and in schools to assist

• students with various mental health and addictions challenges.
• Assess and monitor mental health and addictions concerns
• Connect students with services within the community
• Collaborate with schools, families and care partners, to support a
  student’s care plan, goals and treatments
• Medication assessment, support and education
• Support transitions back to school from hospitals or other care settings

Helping students thrive, cope and succeed:
Living with mental health issues and/or an addiction is difficult for anybody of any age. When you add in the social and academic pressures of being a student, life can sometimes feel unbearable.
Mental Health and Addictions Nurses provide early intervention, psycho-educational support and therapeutic strategies that addresses specific mental health and addiction needs for children and youth.

A guide for patients and families and caregivers
Getting ready to move into a long-term care home can be a challenging time. Knowing this, we are committed to making the process as easy as possible for you and your family/caregivers. Based on your most recent assessment, your care coordinator has determined that you will be prioritized as category 1 (crisis) on the waiting list for all long-term care homes that you select. This category is for people who need immediate admission to long-term care and cannot have their needs met at home.

Bukaan ahaan, xubin qoyska ka tirsan, wakiil qof kale ama daryeele ahaan, waxaad xaq u leedahay inaad fishoo in shaqaale kasta oo ka tirsan Ontario Health atHome, xubin ka tirsan Guddiga iyo bixiye adeeg caafimaad oo qandaraas la galay uu ixtiraamo oo uu kor ugu qaado xuquuqdaada sida soo socota:

Ontario Health atHome Posting of Travel, Meal and Hospitality Board of Directors Expense for Quarter 3 – Fiscal Year 2025/26

Ontario Health atHome Posting of Travel, Meal and Hospitality.
Executive Expense Report for Designated Individuals for Quarter 3 – Fiscal Year 2025-26

Within this report is Ontario Health atHome’s Annual Report for 2024/25 (Q2-Q4 June 28, 2024 to March 31, 2025). Our report begins on page 86.

*Requests are only for Hospital to Home (H2H) patients already being supported by H2H program within the community
**Hospital based patients are to be initiated as per hospital Ontario Health atHome processes
Please fax completed form to Ontario Health atHome H2H ODB team at 1-877-546-4311

Confirmation of medical stability and program readiness
Inpatient rehabilitative care and other complex continuing care
Do NOT use this application for Palliative care referrals.

Prequalification Status Expires December 31, 2027
Service providers identified below have prequalified to bid on Ontario procurements for selected home care services.
Note: Prequalification levels are confidential to Ontario Health atHome, Ontario Health and the individual service providers.

Designated Public Sector Accessibility Compliance Report
Section 15 of the Accessibility for Ontarians with Disabilities Act, 2005 (AODA) requires that accessibility reports include a statement certifying that all the required information has been provided and is accurate, signed by a person with authority to bind the organization(s).

Public organizations, non-profits, and private businesses must complete an AODA (opens in a new tab) compliance report. This report is a way to make sure that organizations are on track with the goal of making a fully accessible province by 2025. This report confirms that businesses have met their AODA needs (opens in a new tab) .

Approval Date: December 2025
Updates: To receive this document in an alternate format at no cost, please contact Ontario Health atHome’s Communications Team by the means listed below:
Email: accessibility@ontariohealthathome.ca
Phone: 1-888-470-2222
TTY: 711

December 2025
As an agency in its first full year, Ontario Health atHome has made significant advancements towards harmonizing our approach to reducing and removing barriers while also improving access to services in an inclusive employment environment.
To receive this document in an alternate format at no cost, please contact Ontario Health atHome’s Communications Team by the means listed below:

Email: accessibility@ontariohealthathome.ca
Phone: 310-2222
TTY: 711

Ontario Health atHome policies are an important part of developing an organizational culture that connects and inspires all team members across the province.
This policy sets out Ontario Health atHome’s commitment to accessibility in accordance with the Accessibility for Ontarians with Disabilities Act, 2005 (“AODA”) (opens in a new tab) and Ontario Regulation 191/11: Integrated Accessibility Standards (“IASR”) (opens in a new tab) , under the AODA. This policy should be read in conjunction with Ontario Health atHome’s AODA Multi-Year Accessibility Plan (“MYAP”).

Effective Date: February 25, 2026
Note: Manufacturer Back Order and Discontinuation lists are reviewed and validated on a weekly basis and will be updated
if there are changes to the list

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Medical Referral Paediatric for patients under 18 years of age.
Patients may have care in a nursing clinic and be taught their treatments based on nurses discretion.

Nursing services are primarily provided in clinics, with in-home care only by exception. Prescribers must ensure therapy is appropriate and safe; first dose requests may take longer and are at the nursing provider’s discretion. Patients receive self-management teaching and follow-up, and services are not duplicated. Ineligible medications include blood products, naturopathic, and experimental treatments.

For Adults 18 years +
First dose requests may take longer to process and the decision to administer the first dose parenteral medication is made by the Service Provider.

Nursing services are primarily provided in clinics, with in-home care only by exception. Prescribers must ensure therapy is appropriate and safe; first dose requests may take longer and are at the nursing provider’s discretion. Patients receive self-management teaching and follow-up, and services are not duplicated. Ineligible medications include blood products, naturopathic, and experimental treatments.

For Adults 18 years +
First dose requests may take longer to process and the decision to administer the first dose parenteral medication is made by the Service Provider.

Nursing services are primarily provided in clinics, with in-home care only by exception. Prescribers must ensure therapy is appropriate and safe; first dose requests may take longer and are at the nursing provider’s discretion. Patients receive self-management teaching and follow-up, and services are not duplicated. Ineligible medications include blood products, naturopathic, and experimental treatments.

Nursing services are primarily provided in clinics, with in-home care only by exception. Prescribers must ensure therapy is appropriate and safe; first dose requests may take longer and are at the nursing provider’s discretion. Patients receive self-management teaching and follow-up, and services are not duplicated. Ineligible medications include blood products, naturopathic, and experimental treatments.

Nursing services are primarily provided in clinics, with in-home care only by exception. Prescribers must ensure therapy is appropriate and safe; first dose requests may take longer and are at the nursing provider’s discretion. Patients receive self-management teaching and follow-up, and services are not duplicated. Ineligible medications include blood products, naturopathic, and experimental treatments.

Nursing services are primarily provided in clinics, with in-home care only by exception. Prescribers must ensure therapy is appropriate and safe; first dose requests may take longer and are at the nursing provider’s discretion. Patients receive self-management teaching and follow-up, and services are not duplicated. Ineligible medications include blood products, naturopathic, and experimental treatments.

Nursing services are primarily provided in clinics, with in-home care only by exception. Prescribers must ensure therapy is appropriate and safe; first dose requests may take longer and are at the nursing provider’s discretion. Patients receive self-management teaching and follow-up, and services are not duplicated. Ineligible medications include blood products, naturopathic, and experimental treatments.

For Adults 18 years +
First dose requests may take longer to process and the decision to administer the first dose parenteral medication is made by the Service Provider.

Nursing services are primarily provided in clinics, with in-home care only by exception. Prescribers must ensure therapy is appropriate and safe; first dose requests may take longer and are at the nursing provider’s discretion. Patients receive self-management teaching and follow-up, and services are not duplicated. Ineligible medications include blood products, naturopathic, and experimental treatments.

For Adults 18 years +
First dose requests may take longer to process and the decision to administer the first dose parenteral medication is made by the Service Provider.

For Adults 18 years +
First dose requests may take longer to process and the decision to administer the first dose parenteral medication is made by the Service Provider.

Reference Document: Community Adult Flushing and Vascular Access Maintenance Protocol for Central Venous Access Devices (CVAD) and Peripheral Intravenous Catheters (PIVC)

For Adults 18 years +
First dose requests may take longer to process and the decision to administer the first dose parenteral medication is made by the Service Provider.

Nursing services are primarily provided in clinics, with in-home care only by exception. Prescribers must ensure therapy is appropriate and safe; first dose requests may take longer and are at the nursing provider’s discretion. Patients receive self-management teaching and follow-up, and services are not duplicated. Ineligible medications include blood products, naturopathic, and experimental treatments.

For Adults 18 years +
First dose requests may take longer to process and the decision to administer the first dose parenteral medication is made by the Service Provider.

For Adults 18 years +
First dose requests may take longer to process and the decision to administer the first dose parenteral medication is made by the Service Provider.

For Adults 18 years +
First dose requests may take longer to process and the decision to administer the first dose parenteral medication is made by the Service Provider.

For Adults 18 years +
First dose requests may take longer to process and the decision to administer the first dose parenteral medication is made by the Service Provider.

Nursing services are primarily provided in clinics, with in-home care only by exception. Prescribers must ensure therapy is appropriate and safe; first dose requests may take longer and are at the nursing provider’s discretion. Patients receive self-management teaching and follow-up, and services are not duplicated. Ineligible medications include blood products, naturopathic, and experimental treatments.

For Adults 18 years +
First dose requests may take longer to process and the decision to administer the first dose parenteral medication is made by the Service Provider.

Nursing services are primarily provided in clinics, with in-home care only by exception. Prescribers must ensure therapy is appropriate and safe; first dose requests may take longer and are at the nursing provider’s discretion. Patients receive self-management teaching and follow-up, and services are not duplicated. Ineligible medications include blood products, naturopathic, and experimental treatments.

For Adults 18 years +
First dose requests may take longer to process and the decision to administer the first dose parenteral medication is made by the Service Provider.

For Adults 18 years +
First dose requests may take longer to process and the decision to administer the first dose parenteral medication is made by the Service Provider.

For Adults 18 years +
First dose requests may take longer to process and the decision to administer the first dose parenteral medication is made by the Service Provider.

Nursing services are primarily provided in clinics, with in-home care only by exception. Prescribers must ensure therapy is appropriate and safe; first dose requests may take longer and are at the nursing provider’s discretion. Patients receive self-management teaching and follow-up, and services are not duplicated. Ineligible medications include blood products, naturopathic, and experimental treatments.

Nursing services are primarily provided in clinics, with in-home care only by exception. Prescribers must ensure therapy is appropriate and safe; first dose requests may take longer and are at the nursing provider’s discretion. Patients receive self-management teaching and follow-up, and services are not duplicated. Ineligible medications include blood products, naturopathic, and experimental treatments.

Nursing services are primarily provided in clinics, with in-home care only by exception. Prescribers must ensure therapy is appropriate and safe; first dose requests may take longer and are at the nursing provider’s discretion. Patients receive self-management teaching and follow-up, and services are not duplicated. Ineligible medications include blood products, naturopathic, and experimental treatments.

Fax form to CBA team at 519-742-0635

Highland Retirement Home
20 Fieldgate St, Kitchener, ON

Stone Lodge Retirement Residence
165 Cole Rd, Guelph, ON

If you have received information directly from the long-term care home where you are staying, please use in conjunction with this information.

Ontario Health atHome Posting of Travel, Meal and Hospitality.
Executive Expense Report for Designated Individuals for Quarter 2 – Fiscal Year 2025-26

Ontario Health atHome Posting of Travel, Meal and Hospitality Board of Directors Expense for Quarter 2 – Fiscal Year 2025/26

Pediatric Patients at McMaster Children’s Hospital (MCH) Hamilton
Toll Free Phone Number: 1-800-810-0000

ਇੱੱਕ ਮਰੀੀਜ਼, ਪਰਿਰੀਵਾਾਰੀਕ ਮਂਬਰੀ, ਬਦਲਵਾਂ ਫੈੈਸਲੇ ਲੈ ਣ ਵਾਾਲੇ ਜਾਂਾ� ਦੇਖਭਾਾਲ ਕਰੀਨ ਵਾਾਲੇ ਦੇ ਤੌੌਰੀ ‘ਤੌੇ, ਤੌੁਹਾਾਨ� ੰ ਇੱਹਾ ਉਮੀਦ ਕਰੀਨ ਦਾ ਅਰਿ�ਕਾਰੀ ਹਾੈ ਰਿਕ ਹਾਰੀ ਓਨਟਾਾਰੀੀਓ ਹਾੈਲਥ ਐਟਾ ਹਾੋਮ ਕਰੀਮਚਾਾਰੀੀ, ਬੋਰੀਡ ਮਂਬਰੀ ਅਤੌੇ ਇੱਕਰੀਾਰੀਨਾਮੇ ਵਾਾਲੇ ਰਿਸਹਾਤੌ ਸੇਵਾਾਵਾਾ� ਦੇਣ ਵਾਾਲਾ ਤੌੁਹਾਾਡੇ ਅਰਿ�ਕਾਰੀਾ� ਦਾ ਸਰਿਤੌਕਾਰੀ ਅਤੌੇ ਪਰਚਾਾਰੀ ਕਰੀੇਗਾਾ ਰਿਜਾਂਵਾਂ ਰਿਕ

Jako pacjent, członek rodziny lub opiekun, masz prawo oczekiwać, że każdy pracownik Ontaryjskiej Służby Zdrowia w Domu ( Ontario Health at Home), członek zarządu lub kontraktor świadczący usługi medyczne będzie szanować i promować Twoje prawa. Jako konsument masz prawo

身為病患、家屬、替代決策者或照護人員，您有權期望每位安大略居家保健員工、董事會成員和簽約醫療服務提供者尊重並促進您的以下權利

Form ONC 537 E MR22 for Service Providers
Nursing Agency to fax the completed and/or reviewed HPP to the appropriate Primary Health Care Provider(s) and Funeral Director (if consent obtained).
Nursing Agency to send completed and/or revised HPP to Ontario Health atHome via Health Partner Gateway (HPG).
When HPG is unavailable, fax to:
Chatham: 519-351-5842
Windsor: 519-258-6288
Sarnia: 519-337-4331

Quyền của Bệnh nhân
Là bệnh nhân, thành viên gia đình, người ra quyết định thay thế hoặc người chăm sóc, bạn có quyền mong đợi mọi nhân viên, thành viên Hội đồng Quản trị và nhà cung cấp dịch vụ y tế theo hợp đồng của Sức khỏe tại nhà Ontario sẽ tôn trọng và thúc đẩy các quyền của bạn như sau:

रोगी अधिकार विधेयक

एक रोगी, परिवार के सदस्य, वैकल्पिक निर्णयकर्ता या देखभालकर्ता के रूप में, आपको यह अपेक्षा करने का अधिकार है कि ओंटारियो हेल्थ एटहोम का प्रत्येक कर्मचारी, बोर्ड सदस्य और अनुबंधित स्वास्थ्य सेवा प्रदाता आपके निम्नलिखित अधिकारों का सम्मान और संवर्धन करेगा:

We strive to provide outstanding care to all Ontario Health atHome patients. Hearing from you helps us strengthen services and patient experiences.

Please Fax Hospice applications and eShift PCCRs as these are considered Urgent.

Completed by a Coordinated Bed Access Coordinator (Ontario Health atHome staff) for transfers in the rehab bed program.
Please fax completed form and updated letter of understanding to Ontario Health atHome (519) 742-0635
For Neurobehavioural and Geriatric Assessment Units fax to (519) 749-4326

Coordinated Bed Access referrals are coordinated by Ontario Health atHome WW. The Hospital will be sharing your medical and personal information with Ontario Health atHome WW. Ontario Health atHome WW will add your name to the waiting list. Your initials and gender will be accessible to Ontario Health atHome WW’s other hospital partners. The hospital and Ontario Health atHome WW will share your medical and personal information with the Rehabilitation program.

Info for Service Providers

Info for Services Providers

Fax: 1-855-697-7358

*Hospital: Use hospital Ontario Health atHome fax number

Effective September 30, 2025
Fax: 1-855-697-7358

*Hospital: Use hospital Ontario Health atHome fax number

Effective September 30, 2025
Fax: 1-855-697-7358
*Hospital: Use hospital Ontario Health atHome fax number

Fax: 1-855-697-7358

*Hospital: Use hospital Ontario Health atHome fax number

Effective September, 2025
Fax: 1-855-697-7358

*Hospital: Use hospital Ontario Health atHome fax number

Statement of financial position for Ontario Health atHome as at March 31, 2025
Management of Ontario Health atHome is responsible for the integrity, consistency, objectivity and reliability of the financial statements. These financial statements have been prepared by management in accordance with Canadian public sector accounting standards including the 4200 series for government not-for-profit organizations and, where appropriate, include amounts based on management’s best estimates and judgements. Estimates and assumptions are based on historical experience, current conditions and various other assumptions believed to be reasonable in the circumstances.

Palliative Symptom Relief Kit (SRK) – Temiskaming District – Kirkland Lake Area Prescriber Order Form
NOTE: This form must be faxed to Ontario Health atHome at 705-567-9407

Palliative Symptom Relief Kit (SRK) – Sudbury Prescriber Order Form
Please fax to Ontario Health atHome Care Coordinator @ 705-522-3855
The Ontario Health atHome Care Coordinator will send a copy of the form to:
• Robinson’s Pharmacy Sudbury
• Community Nursing Provider

Palliative Symptom Relief Kit (SRK) – Sault Ste. Marie Prescriber Order Form
FAX to: Ontario Health at Home 705-949-1663

Palliative Symptom Relief Kit (SRK) – Parry Sound Prescriber Order Form
ONLY a Ontario Health atHome Healthcare Provider may access kit for first dose. To be dispensed with Supply kit (SIV 0220).
Please fax to 1-855-773-4056.The Care Coordinator will send a copy of the form to: Pharmasave Lane Family Pharmacy & Community Nursing Provider

Palliative Symptom Relief Kit (SRK) – North Bay Prescriber Order Form
Please fax completed form to Robinson’s Pharmasave
• North Bay Location (705) 495-4059 (Nipissing Region/Sturgeon Falls/Burk’s Falls/New Liskeard)
• Sudbury Location (705) 560-6751 (Sudbury/Parry Sound/Port Loring)

Palliative Symptom Relief Kit (SRK) – Manitoulin Island Prescriber Order Form
1. Prescribers: Fax to patients pharmacy of choice:
I. Guardian Pharmacy – Gore Bay (705-282-0792), Little Current (705-368-2077),
Manitowaning (705-859-2280), or Mindemoya (705-377-5310)
II. Edgewater Pharmacy – Little Current (705-368-3131)
AND
2. Pharmacists: Fax to Ontario Health atHome (705-522-3855) to ensure CC can order supplies to
patients pharmacy of choice

Palliative Symptom Relief Kit (SRK) – Cochrane District – Kapuskasing Prescriber Order Form
Procedure:
1. Place your initials and ✪dosing in the column of the table for any medications to be included in the SRK.
2. Fax to Ontario Health atHome at (705-267-7795)
3. Fax to patient’s participating pharmacy of choice:
i. Wal-Mart (855-983-1050)
ii. Shopper’s Drug Mart (705-337-1661)
iii. Rexall (705-337-1877)
4. Family to pick-up SRK & Supplies at dispensing pharmacy.
5. SRK is for short term use only. Prescriptions must be sent for ongoing use for specific medications needed.

Memorandum of Understanding Among Minister of Health, Chair of Ontario Health, and Chair of Ontario Health at Home
The purpose of this tripartite Memorandum of Understanding (MOU) is to:

• Establish the accountability relationships among the Minister of Health, the Chair of Ontario Health and the Chair of Ontario Health atHome;
• Clarify the roles and responsibilities of the Minister, the Agency Chair, the Subsidiary Chair, the Deputy Minister, the Agency CEO, the Agency’s Board, the Subsidiary CEO, and the Subsidiary’s Board.
• Clarify the operational, administrative, financial, staffing, auditing, and reporting arrangements among Ontario Health atHome, Ontario Health and the Ministry of Health.

* Note: Medical conditions must be stable, managed in an RN/RPN scope, not require daily MD assessment.

Information on planning and applying for long-term care
Relocating from one home to another can be challenging – and this includes deciding whether to move into a long-term care home.
We are here to help you and your family understand and make the right decision about your readiness and eligibility for long-term care.

Ontario Health atHome Posting of Travel, Meal and Hospitality Board of Directors Expense for Quarter 1 – Fiscal Year 2025/26

Ontario Health atHome Posting of Travel, Meal and Hospitality.
Executive Expense Report for Designated Individuals for Quarter 1 – Fiscal Year 2025-26

*Patients requiring palliative care can be admitted from any sending facility in the system, including Home (admissions from LTC will be considered on a case-by-case basis after a palliative pain an symptom managing consult is completed).

當您在家獨立生活變得困難時，長期護理院是讓您安全、舒適和有尊嚴地生活的地方。長期護理 院有時被稱為療養院。
長期護理院提供：
• 24小時院內護理服務
• 由長期護理醫療團隊提供初級保健護理
• 所有膳食（包括對飲食的醫療限制）
• 個人護理方面的日常協助 – 例如洗澡、穿衣和飲食
• 住宿配備基本家具，包括床、椅子和床單
• 洗衣和家務
• 宗教和心靈服務
• 個人衛生用品
• 藥房服務和護理協助，以管理您的藥物和臨床用品
• 社交和娛樂項目
• 安全可靠的環境
• 一些長期護理院還提供短期住宿床位選擇，例如暫托和康復護理
• 社工服務
• 治療服務

我們隨時為您提供幫助。「安省家居保健」組織每個月為全省各地超過400,000名患者協調家居 和社區護理。
我們的使命是通過互聯、便利、以患者為中心的護理，幫助每個人在家裡改善健康。
我們評估患者的護理需求，並提供以家居和社區為基礎的服務以支持您的健康和福祉。我們還提 供社區其他服務的獲取和轉介，並管理安大略省長期護理院的申請和入院流程。
我們與安大略省衛生團隊、家庭醫生、醫院和許多其他衛生系統合作夥伴合作，以支持高質 量、綜合性的護理規劃和服務。

Consolidated Home and Community Care Support Services Annual Report, 2023/24 + Q1 2024/25
In 2023/24 and Q1 2024/25, Home and Community Care Support Services focused on delivering on our mandate, while making progress in achieving our Annual Business Plan goals. We refined and streamlined processes in anticipation of our amalgamation to form a unified organization.

356 Oxford Street West London, ON N6H 1T3
Telephone: 1-877-900-5667 Fax: 519-657-4578

Last Update: June 2025
Fax: 1-855-697-7358

*Hospital: Use hospital Ontario Health atHome fax number

The senior support team respects and values the dignity of all persons. We are sensitive to issues of diversity in background, social status, abilities and sexual orientations. waterloo wellington

Ontario Health atHome Posting of Travel, Meal and Hospitality.
Executive Expense Report for Designated Individuals for Quarter 4 – Fiscal Year 2024-25

Ontario Health atHome Posting of Travel, Meal and Hospitality Board of Directors Expense for Quarter 4 – Fiscal Year 2024/25

The Expected Death in the Home (EDITH) protocol supports end-of-life care based on an individual’s expressed wish to die at home and not to be resuscitated when they stop breathing or their heart stops. An expected death refers to when, in the opinion of a health care team, the patient is irreversibly and irreparably terminally ill; that is, there is no available treatment to restore health, or the patient refuses the available treatment.

The Short-Term Transitional Care Unit (TCU) Program is a collaborative initiative co-developed with the clinical leadership of Ontario Health atHome and CareKW. Our shared objective is to provide patients with a supportive environment where they can receive the necessary care to facilitate their transition to an alternative living arrangement that aligns with their care needs.

The submission of this completed form for nursing and supplies facilitates the delivery of the MAiD kit (i.e., supplies only and no medications) to the location you identify below, where the MAID procedure will take place.

The Expected Death in the Home (EDITH) protocol supports end-of-life care based on an individual’s expressed wish to die at home and not to be resuscitated when they stop breathing or their heart stops. An expected death refers to when, in the opinion of a health care team, the patient is irreversibly and irreparably terminally ill; that is, there is no available treatment to restore health, or the patient refuses the available treatment.

Elevating extraordinary people, Advancing exceptional care

At Ontario Health atHome, our people are our greatest asset. Rooted in
our mission, vision and values, our People Strategy is refreshed annually to reflect evolving priorities.

Medical Equipment Vendor Order Trackers allow you to track orders with:
Medigas: Central, Central West, Mississauga Halton, North Simcoe Muskoka, Toronto Central, North East and North West
Ontario Medical Supply: Central East, Champlain and South East
Rexall: Erie St. Clair, Hamilton Niagara Haldimand Brant, South West and Waterloo Wellington

Revised: June 5, 2025

Ontario Medical Supply (OMS) Medical Equipment Catalogue for the following areas: Cental East, Champlain and South East
March 2025

Rexall Medical Equipment Catalogue for the following area: Erie St. Clair, Hamilton Niagara Haldimand Brant, South West and Waterlook Wellington

March 2025

Medigas Medical Equipment Catalogue for the following areas: North East and North West
December 2025

Medigas Medical Equipment Catalogue for the following areas: Central, Central West, Mississauga Halton, North Simcoe Muskoka, and Toronto Central
December 2025

La sécurité des patients est notre priorité absolue. La présente feuille de renseignements a pour objet d’aider les patients, leur famille et leurs soignants à comprendre l’importance de la sécurité des lits ainsi que les risques qui s’y rattachent, notamment le piégeage.
Si vous avez des questions ou des préoccupations au sujet de la sécurité des lits, parlez-en à votre coordonnateur ou coordonnatrice de soins.

Patient safety is our top priority. This information sheet is to help patients, families and caregivers understand bed safety and risks, including entrapment.
If you have any bed safety questions or concerns, please speak with your Care Coordinator.

Effective March 18, 2025
This document provides a formulary listing of medical equipment categorized by vendor, item code, item description, product category and manufacturer name.

For information on extended manufacturer medical equipment and supply outages, please refer to the MES Manufacturer Backorder Report.

Contract Stream Implementation for Medical Equipment
Frequently Asked Questions for Health System Partners

356 Oxford Street West London, ON N6H 1T3
Telephone: 1-855-474-5754 Fax: 519-472-3257
** Orders with less than 48 hours notice require a call to 519-474-5754 to confirm**
For support, or to ensure receipt of a new order sent between 2:00 pm Friday and 8:00 am Monday (and holidays), please call 519-474-5754

Ontario Health atHome Posting of Travel, Meal and Hospitality.
Executive Expense Report for Designated Individuals for Q3 2024-25

Ontario Health atHome Posting of Travel, Meal and Hospitality Board of Directors Expense for Quarter 3 – Fiscal Year 2024/25

Multi-factor authentication (MFA; two-factor authentication, or 2FA, along with similar terms) is an electronic authentication method in which a user is granted access to a website or application only after successfully presenting two or more pieces of evidence (or factors). MFA helps protect personal data from being accessed by an unauthorized party by adding an additional layer of protection to traditional passwords. This guide covers how to use one method of MFA, Microsoft Authenticator.

Enabling students with medical needs to succeed in education
Ontario Health atHome’s School Health Support Services program is designed to support children with medical needs – whether a short or long-term illness, physical disability, medically complex condition or requiring assistance following an injury or hospital stay.

This document provides a list of infusion and supply kit contents categorized by kit name and component items within each kit. Effective September 30, 2025

Permettre aux élèves ayant besoin de soins médicaux de réussir à l’école
Le programme de Services auxiliaires de santé dans les écoles de Santé à domicile Ontario a été conçu pour soutenir les enfants ayant besoin de soins médicaux en raison d’une maladie de courte ou de longue durée, d’un handicap physique ou d’un problème de santé complexe et ceux qui ont besoin d’aide après une blessure ou une hospitalisation récente.

Dans le cadre du Programme de reconnaissance de soignants « Au-delà du devoir », on célèbre et honore une fois par année les soignants (membres de la famille, amis et voisins, entre autres) dont la gentillesse, le dévouement et le soutien permettent aux gens de vivre à la maison, malgré les problèmes liés à la vieillesse, à une maladie ou à un handicap. L’objectif du programme est de reconnaître les soignants en Ontario qui incarnent les valeurs de Santé à domicile Ontario, soit la collaboration, le respect, l’intégrité et l’excellence.

The annual Above and Beyond Caregiver Recognition Program celebrates and honours caregivers (family members, friends, neighbours, etc.) whose kindness, dedication, and support enables people to live at home despite the impacts of age, illness or disability. The program is designed to recognize caregivers that live the Ontario Health atHome Values of collaboration, respect, integrity and excellence.

Please use the following checklist to help you be prepared to manage your health and know where to get care during the fall, winter and holiday periods.

CPS fax: 1-866-675-0885
*Hospital: Use hospital Ontario Health atHome fax number

Ontario Health atHome Posting of Travel, Meal and Hospitality Executive Leadership Expense for Quarter 2 – Fiscal Year 2024/25

Ontario Health atHome Posting of Travel, Meal and Hospitality Board of Directors Expense for Quarter 2 – Fiscal Year 2024/25

Santé àdomicile Ontario signe une entente contractuelle avec tous les patients du Programme de soins àdomicile gérés par la famille. Dans cette entente, on présente les détails les plus importants tels que le plan de soins du patient, les exigences en matière de présentation de rapports mensuels ainsi que des données financières.

• La nouvelle entente contractuelle comporte le versementd’un dépôt le premier jour de chaque mois.
• Les patients n’ont plus àpayer de leur poche pour lesservices de soins àdomicile.
• Ils doivent présenter des rapports mensuels.

Every patient on Family-Managed Home Care has a contract with Ontario Health atHome that outlines key details like the patient care plan, monthly reporting requirements and financial details.

• The new contract features pre-flowed funding on thefirst day of each month
• Patients no longer need to pay out-of-pocket for homecare services
• Required to submit monthly reporting documents

Service Provider Organizations must provide services in French. The availability of bilingual staff may vary depending on the patient needs and health care.

Les organismes fournisseurs de services doivent offrir des services en français. La disponibilité d’employés bilingues peut varier en fonction des besoins du patient et des soins de santé.

Last update: November 2025

Fax: 905-855-8989 / 1-877-298-8989

*Hospital: Use hospital Ontario Health atHome fax number

Fax: 905-855-8989 / 1-877-298-8989

*Hospital: Use hospital Ontario Health atHome fax number

Fax: 905-855-8989 / 1-877-298-8989

*Hospital: Use hospital Ontario Health atHome fax number

Fax: 905-855-8989 / 1-877-298-8989

*Hospital: Use hospital Ontario Health atHome fax number

Le présent accord a pour but d’établir les conditions générales selon lesquelles Santé Ontario fournira
un financement à Santé à domicile Ontario, afin de lui permettre de s’acquitter de ses obligations en
vertu du présent Accord et de remplir ses obligations légales en vertu de la Loi pour des soins de santé
connectés (CCA). Le présent Accord constitue un accord de responsabilisation de service tel que défini
dans la Loi pour des soins de santé connectés (CCA).

The purpose of this agreement is to set out the terms and conditions on which Ontario Health will provide funding to Ontario Health atHome, to enable Ontario Health atHome to perform its obligations under this Agreement and fulfills its statutory obligations under the Connection Care Act. This Agreement is a service accountability agreement as defined in the Connecting Care Act.

Sommaire du processus de demande au Programme de soins à domicile gérés par la famille
Grâce au Programme de soins à domicile gérés par la famille, les patients et les mandataires spéciaux admissibles reçoivent du financement pour embaucher des fournisseurs de services de soins et payer leurs services de soins à domicile. L’équipe peut, à tout moment, répondre aux questions que vous pouvez avoir au sujet du programme ou de votre admissibilité.
Si vous voulez en savoir plus, visitez la page web : Soins à domicile gérés par la famille.

Through the Family-Managed Home Care program, eligible patients or their substitute decision makers, receive funding to purchase home care services or employ care providers. The team can answer any questions you may have about the program or your eligibility at any time.
To learn more, please visit Family-Managed Home Care

Statement of financial position for Central East as at June 27, 2024

Statement of financial position for Central as at June 27, 2024

Statement of financial position for Champlain as at June 27, 2024

Statement of financial position for Central West as at June 27, 2024

Statement of financial position for Erie St. Clair as at June 27, 2024

Statement of financial position for Hamilton Niagara Haldimand Brant as at June 27, 2024

Statement of financial position for Mississauga Halton as at June 27, 2024

Statement of financial position for North East as at June 27, 2024

Statement of financial position for North Simcoe Muskoka as at June 27, 2024

Statement of financial position for North West as at June 27, 2024

Statement of financial position for South East as at June 27, 2024

Statement of financial position for South West as at June 27, 2024

Statement of financial position for Toronto Central as at June 27, 2024

Statement of financial position for Waterloo Wellington as at June 27, 2024

Note: A signed prescription for feed including type and rate, as well as a completed Nutrition Products
Form from the physician must be faxed to the pharmacy providing the feed.
Fax: 519-472-4045

Note: A signed prescription for feed including type and rate, as well as a completed Nutrition Products Form
from the physician must be faxed to the pharmacy providing the feed.
Fax: 519-472-4045

Fax: 1-844-858-3546/ Toll Free

*Hospital: Use hospital Ontario Health atHome fax number

Fax: 1-844-858-3546/ Toll Free

*Hospital: Use hospital Ontario Health atHome fax number

Fax: 1-844-858-3546/ Toll Free

*Hospital: Use hospital Ontario Health atHome fax number

Fax: 1-844-858-3546/ Toll Free

*Hospital: Use hospital Ontario Health atHome fax number

Fax: 1-844-858-3546/ Toll Free

*Hospital: Use hospital Ontario Health atHome fax number

Wound Care and General Supply Order Form for Central West area

Urinary Continence Supply Order Form for Central West area

Respiratory Therapy Supply Order Form for Central West area

Ostomy Supply Order Form for Central West area

Infusion and Enteral Supplies Order Form for Central West area

Effective September 30, 2025
This document provides a formulary listing of Fulfilment supplies available to order categorized by Vendor Contract Type, Master Item Code, Description, and Product Type.
For information on extended manufacturer medical equipment and supply outages, please refer to the MES Manufacturer Backorder Report.

Effective September 30, 2025
This document provides a formulary listing of Infusion and Enteral therapy supplies by geography available to order categorized by Vendor Contract Type, Master Item Code, Description, and Item Unit Type.
For information on extended manufacturer medical equipment and supply outages, please refer to the MES Manufacturer Backorder Report.

For out of region referrals, fax to Ontario Health atHome (OHaH) at:
London Middlesex: 519-472-3257
Elgin: 519-631-6968
Oxford: 519-539-6351
Huron Perth: 519-273-6454
Grey Bruce: 519-881-1425
If admission to Parkwood PCU is urgent, please fax to 519-685-4804 as well as Ontario Health atHome.

Order form for supplies and equipment needed for Negative Pressure Wound Therapy in the Central West area

L’Équipe régionale de consultation en soins palliatifs de Champlain est là pour vous appuyer.

L’Équipe régionale de consultation en soins palliatifs constitue un partenariat entre Soins continus Bruyère et Services de soutien à domicile et en milieu communautaire de Champlain. Nous représentons une équipe interprofessionnelle d’experts en soins palliatifs, y compris des infirmières praticiennes, des infirmières de pratique avancée, des infirmiers spécialisés et des médecins.

To refer a patient to (apply for) hospice and hospice-type services

Useful Links for Caregivers and Families
The following resources are available to help you learn more about home and community care services and palliative care.

Helping students thrive, cope and succeed:
Living with mental health issues and/or an addiction is difficult for anybody of any age. When you add in the social and academic pressures of being a student, life can sometimes feel unbearable.
Mental Health and Addictions Nurses provide early intervention, psycho-educational support and therapeutic strategies that addresses specific mental health and addiction needs for children and youth.

Les infirmières et infirmiers en santé mentale et en toxicomanie offrent une intervention précoce, un soutien psycho-éducationnel et des stratégies thérapeutiques afin de répondre aux besoins particuliers des enfants et des jeunes en matière de santé mentale et de lutte contre les dépendances.

Vous avez besoin de soutien en matière de santé mentale ou de toxicomanie?
Nous sommes ici pour vous aider: Les infirmières et infirmiers en santé mentale et en toxicomanie sont à votre disposition durant toute la semaine pour vous offrir le soutien dont vous avez besoin.

Need Mental Health and Addictions Support?
WE’RE HERE TO HELP … Mental Health and Addictions Nurses are available throughout the week to support you.

This form is to be used for completion of the assessment required under the Fixing Long-Term Care Act, 2021 when a person applies for a determination of eligibility for long-term care home admission. The required assessment is of the applicant’s physical and mental health, and the applicant’s requirements for medical treatment and health care. This assessment must be made by a physician or registered nurse.

Vous avez besoin de soutien en matière de santé mentale ou de toxicomanie?
NOUS SOMMES ICI POUR VOUS AIDER …
Les infirmières et infirmiers en santé mentale et en toxicomanie sont à votre disposition durant toute la semaine pour vous offrir le soutien dont vous avez besoin.

L’état de la situation financière au 31 mars 2024 de Waterloo Wellington

L’état de la situation financière au 31 mars 2024 du Centre-Toronto

L’état de la situation financière au 31 mars 2024 de du Sud-Ouest

L’état de la situation financière au 31 mars 2024 du Sud-Est

L’état de la situation financière au 31 mars 2024 du Nord-Ouest

L’état de la situation financière au 31 mars 2024 du Centre-Ouest

L’état de la situation financière au 31 mars 2024 de de Simcoe Nord Muskoka

L’état de la situation financière au 31 mars 2024 du Nord-Est

L’état de la situation financière au 31 mars 2024 de Mississauga Halton

L’état de la situation financière au 31 mars 2024 de Hamilton Niagara Haldimand Brant

L’état de la situation financière au 31 mars 2024 d’Érié St-Clair

L’état de la situation financière au 31 mars 2024 de Champlain

L’état de la situation financière au 31 mars 2024 du Centre

L’état de la situation financière au 31 mars 2024 du Centre-Est

Statement of financial position for Waterloo Wellington as at March 31, 2024

Statement of financial position for Toronto Central as at March 31, 2024

Statement of financial position for South West as at March 31, 2024

Statement of financial position for South East as at March 31, 2024

Statement of financial position for North West as at March 31, 2024

Statement of financial position for North Simcoe Muskoka as at March 31, 2024

Statement of financial position for North East as at March 31, 2024

Statement of financial position for Mississauga Halton as at March 31, 2024

Statement of financial position for Hamilton Niagara Haldimand Brant as at March 31, 2024

Statement of financial position for Erie St. Clair as at March 31, 2024

Statement of financial position for Central West as at March 31, 2024

Statement of financial position for Champlain as at March 31, 2024

Statement of financial position for Central area as at March 31, 2024

Statement of financial position for Central East as at March 31, 2024

Letter of mandate outlining government’s 2024-25 priorities for Home and Community Care Support Services organizations.

Le quatrième plan d’activités annuel donne suite aux efforts réalisés depuis notre création en juillet 2021, mettant en valeur la transition vers un organisme et un rôle
nouveaux dans le système de soins de santé.

Our fourth Annual Business Plan, since our inception in July of 2021, builds on our accomplishments to date, while also focusing on our future transition into a new organization and role within the health care system.

Home and Community Care Support Services Board of Directors Expense Report for Q1 2024/25 Fiscal Year

Home and Community Care Support Services Posting of Travel, Meal and Hospitality Executive Leadership Expense for Quarter 1 – Fiscal Year 2024/25

Need a family doctor or nurse practitioner?
Your new family health care provider might be just a phone call away. Our team of Care Coordinators identifies doctors and nurse practitioners in your community who are accepting patients and links them with people who are looking for a health care provider.

What is the Convalescent Care Program?
Following surgery or serious illness, you may no longer need in-hospital care but you may not be ready to return home safely.
The Convalescent Care Program provides 24-hour care to people who require specific medical and therapeutic services in a supportive environment. The program will help you recover your strength, energy and functioning before returning home.

Vous avez besoin de soutien en matière de santé mentale ou de toxicomanie?
NOUS SOMMES ICI POUR VOUS AIDER …
Les infirmières et infirmiers en santé mentale et en toxicomanie sont à votre disposition durant toute la semaine pour vous offrir le soutien dont vous avez besoin.

Need Mental Health and Addictions Support?
WE’RE HERE TO HELP … Mental Health and Addictions Nurses are available throughout the week to support you.

Aider les élèves à s’épanouir, à composer avec leurs difficultés et à réussir
Vivre avec un problème de santé mentale ou de dépendances est difficile, peu importe l’âge de la personne. Lorsqu’on y ajoute les pressions sociales et scolaires qui reposent sur les épaules d’un élève, la vie peut parfois sembler insupportable.
Les infirmières et infirmiers en santé mentale et en toxicomanie offrent une intervention précoce,
un soutien psycho-éducationnel et des stratégies
thérapeutiques afin de répondre aux besoins
particuliers des enfants et des jeunes en matière de
santé mentale et de lutte contre les dépendances.

Santé à domicile Ontario exploite plus de 135 cliniques de soins infi rmiers communautaires, fournissant des soins infi rmiers spécialisés de haute qualité, sans frais.
Nos cliniques sont à des endroits accessibles, sur rendez-vous seulement, mais nombreuses parmi elles ont des heures d’ouverture prolongées

Helping students thrive, cope and succeed:
Living with mental health issues and/or an addiction is difficult for anybody of any age. When you add in the social and academic pressures of being a student, life can sometimes feel unbearable.
Mental Health and Addictions Nurses provide early intervention, psycho-educational support and therapeutic strategies that addresses specific mental health and addiction needs for children and youth.

Les infirmières et infirmiers en santé mentale et en toxicomanie offrent une intervention précoce, un soutien psycho-éducationnel et des stratégies thérapeutiques afin de répondre aux besoins particuliers des enfants et des jeunes en matière de santé mentale et de lutte contre les dépendances.

Une transition efficace de l’hôpital à la maison est jugée essentielle afin d’obtenir de bons résultats pour les patients et d’éviter leur réadmission à l’hôpital. Dans le cadre du programme d’intervention rapide en soins infirmiers, les patients reçoivent les services nécessaires pour réussir la transition de l’hôpital à la maison.

Le Service d’accueil central en matière de diabète est un service de renvoi simplifié et intégré pour les personnes qui vivent avec le diabète ou sont à risque de développer cette maladie.
Santé à domicile Ontario offre un Service d’accueil central en ma?ère de diabète pour permetre aux patients vivant avec le diabète ou à risque de développer cete maladie d’accéder à des programmes d’éducation en matière de diabète (PED) ou au Centre de soins complexes aux diabétiques (CSCD).

Aider les élèves à s’épanouir, à composer avec leurs difficultés et à réussir
Les infirmières et infirmiers en santé mentale et en toxicomanie offrent une intervention précoce, un soutien psycho-éducationnel et des stratégies thérapeutiques afin de répondre aux besoins particuliers des enfants et des jeunes en matière de santé mentale et de lutte contre les dépendances.

Helping students thrive, cope and succeed:
Mental Health and Addictions Nurses provide early intervention, psycho-educational support and therapeutic strategies that addresses specific mental health and addiction needs for children and youth.

Vous avez besoin de soutien en matière de santé mentale ou de toxicomanie?
Nous sommes ici pour vous aider: Les infirmières et infirmiers en santé mentale et en toxicomanie sont à votre disposition durant toute la semaine pour vous offrir le soutien dont vous avez besoin.

Need Mental Health and Addictions Support?
We’re here to help: Mental Health and Addictions Nurses are available throughout the week to support you.

Effective September 30, 2025
This document provides a simplified formulary listing categorized by Vendor Contract Type, Master Item Code, Description, and Item Unit Type.
For information on extended manufacturer medical equipment and supply outages, please refer to the MES Manufacturer Backorder Report.

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.

Medical Equipment and Supply Fax Number: 1-855-697-7358

*Hospital: Use hospital Ontario Health atHome fax number

Chatham-Kent Health Alliance inpatient referral and treatment form – fillable

Windsor Regional Hospital – Met Campus inpatient referral and treatment form – fillable

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.

Hôtel-Dieu Grace Healthcare inpatient referral and treatment form – fillable

Erie Shores HealthCare inpatient referral and treatment form – fillable

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.

Les infirmières et infirmiers en santé mentale et en toxicomanie sont à votre disposition durant toute la semaine pour vous offrir le soutien dont vous avez besoin.

Les infirmières et infirmiers en santé mentale et en toxicomanie offrent une intervention précoce, un soutien psycho-éducationnel et des stratégies thérapeutiques afin de répondre aux besoins particuliers des enfants et des jeunes en matière de santé mentale et de lutte contre les dépendances.

Note: This form will be effective on July 23, 2024.

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.

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.

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.

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. Form CS 570 OC 24

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.

Fax: 905-855-8989 / 1-877-298-8989
*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.

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.

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.

…

…

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.

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.

Erie Shores HealthCare outpatient referral and treatment form – fillable

Windsor Regional Hospital – Ouellette Campus emergency referral and treatment form – fillable

Windsor Regional Hospital – Met Campus outpatient referral and treatment form – fillable

Windsor Regional Hospital – Ouellette Campus outpatient referral and treatment form – fillable

Windsor Regional Hospital – Met Campus emergency referral and treatment form – fillable

To request the services of the Palliative Care Outreach Team in Hamilton

Symptom Response Kit (SRK) Request Order Form Windsor

If required, Telehomecare staff will fax the referral form to the Primary Care Provider to verify and/or provide any relevant information.
Chatham Branch: Fax: 519-351-5842
Sarnia Branch: Fax: 519-337-4331
Windsor Branch: Fax: 519-258-6288

Providers cupboard usage order form – fillable

Referral and treatment plan form – fillable

Réadaptation après arthroplastie de la hanche ou du genou
Vous avez été adressé au Centre de soins de physiothérapie pour appuyer votre rétablissement après une arthroplastie totale.
Vous aurez accès à des physiothérapeutes hautement qualifiés ainsi que des assistants en physiothérapie qui vous aideront à optimiser votre rétablissement. Les services de
physiothérapie sont entièrement gratuits

Medical update request form – wound

Medical update request form

Erie Shores HealthCare emergency referral and treatment form – fillable

Offloading assessment form – fillable

Office Location: 180 Riverview Dr, Chatham
Fax: 1-519-258-6288

Electrical Stimulation (eSTIM) referral assessment form – fillable

Electrical Stimulation (eSTIM) non-formulary order form – fillable

Chatham-Kent Health Alliance outpatient referral and treatment form – fillable

Chatham-Kent Health Alliance emergency referral and treatment form – fillable

Chatham Branch: Tel: 519 351-5677
Fax: 519-351-5842

Sarnia Branch: Tel: 519-337-1000
Fax: 519-337-4331

Windsor Branch: Tel: 519-258-8211
Fax: 519-258-6288

Bluewater Water Health inpatient referral and treatment form – fillable

Bluewater Water Health outpatient referral and treatment form – fillable

Bluewater Water Health emergency referral and treatment form – fillable

Assessment service plan form – fillable

Hôtel-Dieu Grace Healthcare inpatient referral and treatment form – fillable

Walker assessment eligibility form

Ontario Health atHome end of life SRK is intended to facilitate timely access to a range of medications to relieve a client’s symptoms in the home on an urgent basis; thereby; potentially avoiding an emergency department and/or acute care admission. Physician orders are indicated below and authorized (signed) by the most responsible
physician (MRP). The nurse can only administer those medications in the kit that have valid signed orders noted on this order form.

To order midline catheter maintenance

To order care relating to vascular access devices in adults (in accordance with the Vascular Access Maintenance Protocol)

To order first dose IV medications to be administered to patients in the community. First dose requests may take longer to process and are not appropriate for urgent requirements.

To order administration of influenza vaccine

To order care relating to the Protocol for Home Parenteral Nutrition (PPN or TPN) for adult patients

Complete the Burlington IPCOT referral form and fax supporting documents to: 905-574-6335
– Medical summary/ health history
– Pertinent diagnostic tests
– Current medication lists
– Pharmacy information
– Consult/ progress notes
– Other notes

To order Milrinone Infusion Therapy for adult patients

Paramedic Services will communicate back to Home and Community Care Support Services using the HNHB Community Paramedicine Communication Form.

Serving the Haldimand, Norfolk, Brant, Brantford, Six Nations and Mississaugas of the Credit First Nations
For Stedman & Six Nations Outreach Team (all areas) – Fax: 519-751-7527
For OHaH Nurse Practitioners (Haldimand and Norfolk areas only) – Fax: 1-833-305-1947
For Norfolk Haldimand Community Hospice – Fax: 519-751-7527

Complete the Request for Ontario Health atHome, Hamilton Niagara Haldimand Brant area, services and fax it to the appropriate location. Refer to page 2 of the form for fax numbers.

Primary Care Partners: in addition to using the form above, you may also connect directly with the Care Coordinator aligned with your office/practice.

Mental Health and Addictions Nursing Program Referral Form.

To request the services of the Mental Health & Additions Nurse, the patient must be:

1. A student registered in school and who is no older than 21 years of age (may include home instruction)
2. In need of services or related treatment to an identified and/or suspected mental health and/or addictions issue
3. Aware of and consenting to the referral

Additionally, there must be a clearly defined role for the Mental Health & Addictions Nurse

For Long-Term Care Partners in HNHB. Please complete and fax the Long-Term Care Home Referral for Service form to request one or more of the following services for residents:

• Nursing for teaching of IV Administration
• Speech Language Pathology for Swallowing Assessment

Ontario Health atHome operates over 135 community nursing clinics to provide free, high-quality, specialized nursing care. All of our clinics are by appointment only, in accessible locations, and many have extended operating hours.

To be completed and signed by an HCCSS Care Coordinator to refer a patient to Margaret’s Place for Palliative Overnight Respite care

To order Milrinone Infusion Therapy for pediatric patients

For patients being discharged home from hospital with a new tracheostomy and laryngectomy care for patients being discharged home from hospital

For hospital partners who use Health Partner Gateway to receive patient referrals.

To order the administration of ceftriaxone to patients being discharged from the Brantford Community Healthcare System (BCHS)

For the management of rapid-onset, unanticipated symptoms for patients nearing end–of-life and no longer able to swallow oral medications. The medication on this order form is limited to support short duration of symptom management (48 hours) until further medications are ordered. Note: See Palliative Care Symptom Response Guidelines for more info on how to use the form.

To clearly communicate a patient’s plan of care relating to the provision of CPR.

To identify who will complete pronouncement and certification of death for an expected death at home

Ontario Health atHome Child and Youth Mental Health & Addictions Nursing Program
Fax: 1 (519) 571-3957
A mental health nurse will connect with student, parent and/or guardian to confirm consent and finalize eligibility.

Completed by a Primary Care Physician or Registered Dietician

Completed by Retirement Home(RH) or HCCSS staff to outline services that a patient is currently receiving or may require if moving to a Retirement Home setting

FAX COMPLETED FORM TO Ontario Health atHome: 519-742-0635
How is Crisis defined?
A patient is considered to be “In Crisis” if:
1. Patient and/or caregiver safety is at risk and/or there is a risk that a significant health event and/or challenging end-of-life symptoms cannot be managed in their current setting
2. Patient at risk of requiring ED or acute care admission
3. Community resources have been exhausted and family/ caregivers are unable to cope with the patient’s care needs
4. There is a risk that the services required to meet the patient’s end-of-life care plan goals may not be available in their current setting
5. Patient at risk of not accessing their preferred place of death (considering recent trajectory of the PPS score).

A Palliative Approach to Care – Ontario Health atHome in the area of Hamilton Niagara Haldimand Brant and Burlington provides home and community care and services including care coordination for people who are living with a progressive, life limiting illness.

Information sheet for patients and families.

Acute Care to Rehab & Complex Continuing Care (CCC) Referral
Referrals are coordinated by Ontario Health atHome Waterloo Wellington. Your health care team will be sharing your
medical and personal information with Ontario Health atHome WW and the rehabilitative care program. Ontario Health
atHome WW will add your name to the waiting list. Your initials and gender will be accessible to Ontario Health atHome
WW’s other hospital partners
Fax Completed Form to 519-742-0635

Home and Community Care Support Services Erie St. Clair care coordinators assist you and your family in the long-term care home admission process.

Home and Community Care Support Services Erie St. Clair care coordinators assist you and your family in the long-term care home admission process.

Ontario Health atHome welcomes feedback from our patients, their families, and caregivers. Compliments, concerns, complaints, and other inquiries help us measure our performance, enhance the patient experience, and continually improve our Home and Community Care programs and services. To provide feedback, please contact your Care Coordinator.

WW Adult Mental Health Services_ENG

Ontario Health atHome connects, supports, and cares for patients who have a life-limiting illness. Our skilled team helps patients and families understand their options and provides support for their choices.

Your Recovery at Home
Ask your health care team to help you identify the changes you can expect to your routine and the support you will need.
You may require help with your personal care, taking medication, using equipment, housekeeping, getting to medical appointments and other daily activities.

Your health care team will help connect you to care you need in the community.

WW Rapid Recovery Therapy Program_ENG

Ontario Health atHome Rapid Response Nurses (RRNs) provide complex patients with an intensive level of assessment to ensure medications are taken as instructed; follow-up doctors’ visits are made and kept, and ongoing clinical assessments continue through constant monitoring for up to 30 days after leaving hospital or after referral from a community service agency

WW Managing Total Parenteral Nutrition_ENG

Information for patients about orthopedic clinics.

WW CarePartners PT Care Centre for Hip-Knee Replacement

South West MAID referral form

Please FAX Completed Referral to: Ontario Health atHome School Health Support Services Team VIP Fax Line: Toll Free 1-844-800-4578
Ontario Health atHome School Health Support Services Team VIP Line: Toll Free 1-877-900-5667
An Ontario Health atHome MHAN will contact the student or parent/guardian to determine/confirm consent for appropriate referrals.

Long-Term Care Home Listing in Cambridge, Guelph, Waterloo Region and Wellington County

The Integrated Assisted Living Program for seniors will help you live independently at home with the support you need.

• A care coordinator can connect you to the help you need for personal care and everyday tasks.
• If you are returning home following a hospital stay, a care coordinator can also help you get the personal care and community support you need.
• There is no cost to you for the personal support services that are arranged through Ontario Health atHome.

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Care coordinators assist you and your family in the long-term care home admission process. When you apply for admission, you are encouraged to choose five homes. You will be offered the first one available.

Care coordinators assist you and your family in the long-term care home admission process. When you apply for admission, you are encouraged to choose five homes. You will be offered the first one available.

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Care coordinators assist you and your family in the long-term care home admission process. When you apply for admission, you are encouraged to choose five homes. You will be offered the first one available.

Care coordinators assist you and your family in the long-term care home admission process. When you apply for admission, you are encouraged to choose five homes. You will be offered the first one available.
Before you apply, be sure to tour the homes that interest you. It’s up to you to make tour arrangements by contacting the homes directly. Video tours of long-term care homes can be viewed at www.southwesthealthline.ca (opens in a new tab) . Ask your care coordinator for information about long-term care homes in other counties in South West Ontario.

Care coordinators assist you and your family in the long-term care home admission process. When you apply for admission, you are encouraged to choose five homes. You will be offered the first one available. Ask your care coordinator for information about long-term care homes in other counties in South West Ontario.

Ontario Health atHome operates over 135 community nursing clinics to provide free, high-quality, specialized nursing care.
All of our clinics are by appointment only, in accessible locations, and many have extended operating hours.

Ontario Health atHome operates over 135 community nursing clinics to provide free, high-quality, specialized nursing care.
All of our clinics are by appointment only, in accessible locations, and many have extended operating hours. Community nursing clinics provide publicly-funded, patient-centred, high-quality, specialized nursing care.

A referral form to request a virtual wound consult with an NSWOC/WCS/ET or Nurse Practitioner from the South West Regional Wound Care Program.

Please complete and fax order form to Ontario Health atHome: 519-472-4045 or 1-855-539-6970
For any additional inquiries please call Ontario Health atHome at 1-855-474-5754

The Niagara Palliative Care Outreach Team (PCOT) is a group of specialists, including Nurse Practitioners, Palliative Care Clinician, Navigator and Psychosocial Counsellors.
The services available are:

• Complex pain & symptom management support for end-of-life issues
• Psychosocial-spiritual support, including bereavement follow-up
• Mentorship & coaching

SRK is a temporary or short term solution only.

• The SRK are MD/NP orders to be implemented by a nurse (RN, RPN) when symptoms require urgent intervention to manage acute symptoms and facilitate a comfortable death at home.
• The MRP/NP is to be notified as soon as possible regarding changes in condition necessitating the initiation of orders.
• ALL requested medications must be checked off in the form.

Care coordinators assist you and your family in the long-term care home admission process. When you apply for admission, you are encouraged to choose five homes. You will be offered the first one available.

For Access to Diabetes Education Programs and the Centre for Complex Diabetes Care
Phone: 1-888-997-9996
Fax: 1-905-444-2544
Toll-Free Fax: 1-844-731-2161

Formulaire de renvoi à Télésoins à domicile pour les patients atteints d’une maladie pulmonaire obstructive chronique (MPOC) ou d’une insuffisance cardiaque
congestive.

Qu’est-ce que le Programme de relève et de réduction de la détresse des soignants?
Votre coordonnateur de soins a déterminé que vous êtes admissible au Programme de relève et de réduction de la détresse des soignants. Le programme prévoit un soutien supplémentaire fourni par les préposés aux services de soutien à la personne (PSSP) pour assurer un répit temporaire aux soignants, réduire le fardeau de ces derniers et/ou éviter l’épuisement professionnel.

Que sont les soins de convalescence?
Dans le cadre de ce programme de séjour de courte durée, des soins sont fournis jour et nuit dans des foyers de soins de longue durée aux personnes provenant de l’hôpital ou de la communauté qui ont besoin de services médicaux et de services de thérapie particuliers pour retrouver leurs forces, leur endurance et leur mobilité. Le but consiste à permettre aux patients de recouvrer la capacité fonctionnelle nécessaire pendant qu’ils reçoivent des soins de convalescence pour assurer leur sécurité et leur confort dans leur communauté.

What is Convalescent Care?
This short stay program provides 24-hour care in long-term care homes for people from hospitals or the community who need specific medical and therapy services to regain their strength, endurance and mobility. The goal is for patients to regain significant function during their time in convalescent care to return safely and comfortably to their community.

SouthEasthealthline.ca is a consolidated database and resource tool that provides health service information and helps users better navigate a complex health care system. With nearly 2,500 service listings, this source of easily accessible, reliable information connects people with health services in their local community.