South West area

South West Area Office Locations

  • London
    356 Oxford Street West,
    London, ON, N6H 1T3
    Fax:   519-472-4045
  • Owen Sound
    1415 1st Avenue West,
     Suite 3009,
    Owen Sound, ON, N4K 4K8
    Fax:  519-371-5612
  • St. Thomas
    1063 Talbot Street,
    Unit 70,
    St. Thomas, ON, N5P 1G4
    Fax:   519-631-2236
  • Stratford
    65 Lorne Avenue East
    Stratford, ON, N5A 6S4
    Fax:   519-273-2847
  • Woodstock
    1147 Dundas Street,
    Woodstock, ON, N4S 8W3
    Fax:  519-539-0065

Compliments and Concerns?

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

Email: sw.feedback@ontariohealthathome.ca 

Phone: 519-473-2222 (1-800-811-5146)

Mail:

Ontario Health atHome
Attn: Patient Relations Department
356 Oxford Street West, London, ON N6H 1T3

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
Adult Intravenous Remdesivir Infusion Therapy Order Form

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).

August 14, 2024pdf515 KBsouth-westformspdf
Adult Parenteral Antibiotic Therapy Order Form – EN

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.

August 15, 2024pdf469 KBsouth-westformspdf
Adult Standard Flush Protocol – EN

July 3, 2024pdf314 KBsouth-westformspdf
ARCHES – Short-Term Transitional Care Program

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.

October 3, 2024, pdf670 KBsouth-westforms information-sheetpdf
Diabetes Type 1 Request Treatment Order – EN

Request for Type 1 Diabetes Treatment Order

July 3, 2024pdf92 KBsouth-westformspdf
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

, , , , , , , , , , , , , , September 19, 2024pdf229 KBcentral 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
Hydration Form – EN

July 3, 2024pdf214 KBsouth-westformspdf
IV First Dose and Iron Sucrose Screener – EN

July 3, 2024pdf163 KBsouth-westformspdf
MAID Referral Form – EN

South West MAID referral form

July 3, 2024pdf202 KBsouth-westformspdf
Medical Supplies Order Form – Enteral Feeding – Adult

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

September 26, 2024, pdf121 KBsouth-westforms medical-equipment-and-suppliespdf
Medical Supplies Order Form – Enteral Feeding – Pediatrics

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

September 26, 2024, pdf115 KBsouth-westforms medical-equipment-and-suppliespdf
Mental Health and Addictions Nursing Program (MHAN) 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.

July 31, 2024pdf50 KBsouth-westformspdf
Negative Pressure Wound Therapy Referral 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.

July 19, 2024pdf2 MBsouth-westformspdf
Pain Management Order Form – EN

July 3, 2024pdf247 KBsouth-westformspdf
Palliative Care – Hospice Bed Referral Form

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.

September 11, 2024pdf120 KBsouth-westformspdf
Palliative Care – Community Services Assessment Request

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 **

July 31, 2024pdf81 KBsouth-westformspdf
Physician Notification of Concern or Compliment – EN

July 3, 2024pdf141 KBsouth-westformspdf
Referral/Request for Assessment – EN

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.

July 3, 2024pdf508 KBsouth-westformspdf
Request for Release of Personal Health Information

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

, , , , , , , , , , , , , , September 19, 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
Symptom Response Kit Prescription Form – EN

July 3, 2024pdf2 MBsouth-westformspdf
Wound Consult Request – Virtual – EN

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.

July 3, 2024pdf292 KBsouth-westformspdf