Hamilton Niagara Haldimand Brant area

Information and Referral

310-2222

(no area code required)

Toll-free:1-800-810-0000
Fax: 1-866-655-6402 (for patient-related information and referrals)
TTY:711
Email:access@ontariohealthathome.ca

IMPORTANT: DO NOT send any personal health information. This email is not for patient feedback or referrals. Please call us directly at the numbers listed above. We aim to respond within 72 hours, however, this email account is not checked on weekends or statutory holidays.

Connect with Your Regional Healthline

Hamilton Niagara Haldimand Brant Area Local Offices

  • Hamilton (Corporate Office)
    211 Pritchard Road,
    Unit 1,
    Hamilton, ON, L8J 0G5
  • Niagara
    149 Hartzel Road,
    St. Catharines, ON, L2P 1N6
  • Haldimand-Norfolk / Brant
    195 Henry Street,
    Unit 4, Building 4,
    Brantford, ON, N3S 5C9
  • Burlington
    440 Elizabeth Street,
    4th Floor,
    Burlington, ON, L7R 2M1

Compliments and Concerns?

Please share your feedback with your care coordinator. You may also share compliments or concerns in the following ways:

Email: hnhb.patientrelations@ontariohealthathome.ca

Phone: 1-866-790-4642 ext. 3883

Mail: Attention – Manager, Patient Relations
211 Pritchard Road, Unit 1, Hamilton ON  L8J 0G5

Newsroom and Media Relations

Visit our newsroom for more information on news and events. 

For all media-related enquiries, please contact media@ontariohealthathome.ca.

For non-media-related enquiries, please visit the Contact Us page to access additional contact information.

Forms

TitleSummaryRegionLast ModifiedCategoryFile TypeFile SizeLinkhf:doc_tagshf:doc_categorieshf:file_type
Brant PCOT Referral Form – EN

Referral Form to request the palliative care outreach services in Brant.

July 5, 2024pdf2 MBhamilton-niagara-haldimand-brantformspdf
Burlington PCOT Referral Form

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

July 5, 2024pdf1 MBhamilton-niagara-haldimand-brantformspdf
Ceftriaxone Protocol Medical Referral Form – EN

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

July 5, 2024pdf1 MBhamilton-niagara-haldimand-brantformspdf
Community Paramedicine Communication Form

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

July 11, 2024pdf787 KBhamilton-niagara-haldimand-brantformspdf
First Dose – IV Medications Form – EN

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.

July 5, 2024pdf743 KBhamilton-niagara-haldimand-brantformspdf
Formulaire de demande pour la divulgation de renseignements personnels

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

, , , , , , , , , , , , , , July 8, 2024pdf2 MBcentral central-east central-west champlain erie-st-clair global hamilton-niagara-haldimand-brant mississauga-halton north-east north-simcoe-muskoka north-west south-east south-west toronto-central waterloo-wellingtonformspdf
Haldimand NorfolkPCOT Referral Form – EN

To request the services of the Palliative Care Outreach Teams in Haldimand Norfolk

July 5, 2024pdf2 MBhamilton-niagara-haldimand-brantformspdf
Hamilton PCOT Referral Form

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

July 9, 2024pdf2 MBhamilton-niagara-haldimand-brantformspdf
Home Parenteral Nutrition Medical Order Form – Pediatric at McMaster Children’s Hospital

To order care relating to the Protocol for Home Parenteral Nutrition (PPN or TPN) for pediatric patients at McMaster Children’s Hospital

October 5, 2022pdf2 MBhamilton-niagara-haldimand-brantformspdf
Hospice Referral Form

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

July 5, 2024pdf3 MBhamilton-niagara-haldimand-brantformspdf
HPG User Access Authorization Form – EN

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

July 5, 2024pdf1 MBhamilton-niagara-haldimand-brantformspdf
Influenza Vaccine Form – EN

To order administration of influenza vaccine

July 5, 2024pdf783 KBhamilton-niagara-haldimand-brantformspdf
Information about Palliative Symptom Response Medication – EN

Information sheet for patients and families.

July 5, 2024, pdf152 KBhamilton-niagara-haldimand-brantforms information-sheetpdf
Iron Infusion Order Form

Hamilton Niagara Haldimand Brant, Iron Infusion order form – To order intravenous iron replacement

December 13, 2023pdf2 MBhamilton-niagara-haldimand-brantformspdf
Letter of Understanding – Pronouncement and Certification Death – EN

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

July 5, 2024pdf1 MBhamilton-niagara-haldimand-brantformspdf
Long-Term Care Home Referral for Service – EN

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
• Wound Care
• Speech Language Pathology for Swallowing Assessment

July 5, 2024pdf1 MBhamilton-niagara-haldimand-brantformspdf
Margaret’s Place Palliative Overnight Respite Referral Form – EN

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

July 5, 2024pdf1 MBhamilton-niagara-haldimand-brantformspdf
Medical Order Form – General – EN

To order general medications, including wound care and maintenance for urinary catheters

July 5, 2024pdf705 KBhamilton-niagara-haldimand-brantformspdf
Medical Supplies Catalogue

To order from HNHB’s medical supplies catalogue

December 8, 2022pdf708 KBhamilton-niagara-haldimand-brantformspdf
Medical Supplies Catalogue – EN

To order from HNHB’s medical supplies catalogue

July 5, 2024pdf2 MBhamilton-niagara-haldimand-brantformspdf
MHAN Referral Form – EN

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

July 5, 2024pdf1 MBhamilton-niagara-haldimand-brantformspdf
Midline Catheter Form – EN

To order midline catheter maintenance

July 5, 2024pdf2 MBhamilton-niagara-haldimand-brantformspdf
Milrinone Home Infusion Order Form for Adult Patients – EN

To order Milrinone Infusion Therapy for adult patients

July 5, 2024pdf786 KBhamilton-niagara-haldimand-brantformspdf
Negative Pressure Wound Therapy Referral Form

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.

July 17, 2024pdf1 MBhamilton-niagara-haldimand-brantformspdf
Niagara PCOT Referral Form – EN

To request the services of the Palliative Care Outreach Team in Niagara.

July 5, 2024pdf2 MBhamilton-niagara-haldimand-brantformspdf
Nursing Care Centre – Information Handout HNHB

Nursing Care Centre locations throughout HNHB geography.

December 8, 2022pdf490 KBhamilton-niagara-haldimand-brantformspdf
Palliative Symptom Response Form – EN

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.

July 5, 2024pdf992 KBhamilton-niagara-haldimand-brantformspdf
Palliative Symptom Response Guideline

Guidelines how to use the Palliative Symptom Response Order Form.

December 8, 2022pdf3 MBhamilton-niagara-haldimand-brantformspdf
Pediatric Milrinone Infusion Therapy – EN

To order Milrinone Infusion Therapy for pediatric patients

July 5, 2024pdf2 MBhamilton-niagara-haldimand-brantformspdf
Plan of CPR Treatment Form – Palliative Care – EN

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

July 5, 2024pdf772 KBhamilton-niagara-haldimand-brantformspdf
Protocol for Central Vascular Access Devices – Pediatrics

To order care relating to vascular access devices in children

September 20, 2022pdf2 MBhamilton-niagara-haldimand-brantformspdf
Protocol for Vascular Access Devices Medical Order Form – EN

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

July 5, 2024pdf1 MBhamilton-niagara-haldimand-brantformspdf
Protocol Parenteral Nutrition Medical Order Form – Adult Population – EN

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

July 5, 2024pdf1 MBhamilton-niagara-haldimand-brantformspdf
Referral, Request for Services – EN

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.

July 5, 2024pdf2 MBhamilton-niagara-haldimand-brantformspdf
Request for Release of Personal Health Information

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

, , , , , , , , , , , , , , July 8, 2024pdf2 MBcentral central-east central-west champlain erie-st-clair global hamilton-niagara-haldimand-brant mississauga-halton north-east north-simcoe-muskoka north-west south-east south-west toronto-central waterloo-wellingtonformspdf
Respiratory Therapy Referral Form – EN

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

July 5, 2024pdf1 MBhamilton-niagara-haldimand-brantformspdf
Vancomycin Aminoglycoside Prescription Form

To order IV vancomycin and/or aminoglycosides for patients in the community

September 20, 2022pdf812 KBhamilton-niagara-haldimand-brantformspdf