South West area

Ministry of Health only provides coverage for a maximum of three doses for an eligible patient.
Determining and providing proof of patient eligibility for IV Remdesivir therapy is the Prescriber’s responsibility, namely:
The individual does not require hospitalization;
AND the individual cannot take Paxlovid (nirmatrelvir and ritonavir), e.g., due to a drug interaction or contraindication;
AND the individual has a positive COVID-19 test result (molecular or rapid antigen) and has had symptoms for fewerthan 8 days at the time treatment is initiated (dose 1).

Orders are processed between 8 am– 8pm, 7days/week and require a minimum 4-hour turn around window.
HCCSS South West uses a Clinic First Approach to service delivery.

Through our Available Retirement Care Home Enhanced Supports (ARCHES) to Care Beds Program, we are able to help you move from the hospital to a retirement residence with enhanced supports where you can make important decisions about your future care and living arrangements.

Request for Type 1 Diabetes Treatment Order

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

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

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South West MAID referral form

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

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.

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.

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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.

Hospital referrers, please contact the Ontario Health atHome hospital care coordinator prior to discharge for an assessment to inform service planning.
Please complete the referral form in its entirety and fax completed form to Ontario Health atHome: 519-472-3257
** The referral will be triaged based on the information provided in this form **

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Referral/Request for Assessment in South West area.This is a PDF Interactive form. You have the option to complete all or parts, electronically. When completed, please print and fax to Ontario Health atHome.

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

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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.