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COPD & Heart Failure Telehomecare Referral Form – English

[…] Patient has an established diagnosis of Heart Failure or COPD (with or without co-morbid conditions). Health care provider feels the patient will be capable of using simple in-home monitoring equipment. Patient lives in a residential setting with an active land line (internet or analog phone line). Patient or family caregiver is able to provide […]

Urinary Continence Supply Order Form – English

Page 1 of 2 Version 24 -001 Update: October 15, 2024 (DO NOT FILE IN DMS) Urinary Continence Supply Order Form Date: BRN: Patient Name: Ordered By : Name: Agency: Contact (Phone and Ext): Delivery Priority: ☐ Next Day (Delivery by 9:00pm next day. Order must be processed by 5:00pm) ☐ Non -Urgent (Delivery […]

Urinary Continence Supply Order Form – English

Mississauga Halton Urinary Continence Supply Order Form

Urinary Continence Supply Order Form – English

Mississauga Halton Urinary Continence Supply Order Form

Urinary Continence Supply Order Form – English

North East Urinary Continence Supply Order Form

Urinary Continence Supply Order Form – English

Erie St. Clair Urinary Continence Supply Order Form

Urinary Continence Supply Order Form – English

Page 1 of 2 Version 24 -001 Update: October 15, 2024 (DO NOT FILE IN DMS) Urinary Continence Supply Order Form Date: BRN: Patient Name: Ordered By : Name: Agency: Contact (Phone and Ext): Delivery Priority: ☐ Next Day (Delivery by 9:00pm next day. Order must be processed by 5:00pm) ☐ Non -Urgent (Delivery […]

Regional Palliative Consultation Team (RPCT) Referral Form – English

[…] around-the-clock nursing care through their facility or other home-care program. 3) Hav e a primary care provider who will continue as the most responsible provider and remain in regular contact. The provider needs to be available by phone to RPCT consultants for after -hours emergencies only and will be responsible for completing the medical […]

Negative Pressure Wound Therapy (NPWT) Referral Form – English

[…] Location: Length: cm x Width: cm x Depth: cm ☐ Undermini ng Details if applicable: ☐ Tunneling Details if applicable: 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 […]

Community Engagement Framework – English

[…] Framework | 7 Connecting with Partners • Work with health system partners to develop shared training, tackle comm on  engagement challenges and share best practices. Going forward This vision, outlined by the Framework creates a tangible way forwar d for our engagement  practices across the organization. To work towards this goal, we have ide ntifed four areas of  focus across in the short term, including: Building Structure We will: • Build a provincial engagement team, network, and program to work col laboratively  across the province, including supporting Ontario Health atHome • Establish a provincial community of patients, families, caregivers t o support  engagement opportunities that will inform the work of the organiza tion • Develop an  online platform for patients, families, caregivers that enables navigation and  participation in engagement opportunities and supports staf matching , tracking, and  reporting • Create a provincial council of patients, families, caregivers to adv ise on strategic issues  and priorities Building Awareness We will: • Broadly share information about our provincial engagement program to  share how we  listen to, and partner with, people with lived experience and how they can be invo lved • Promote our engagement program broadly (externally and internally) to improve  understanding of what engagement is and how it adds value to our programs and  services Building Relationships We will: • Reconnect with existing Advisors to better understand their skills, exper iences, interests  and future involvement • Recruit patients, families, caregivers from across the Province, w […]

CEN-NPWT-Referral-From-EN

[…] chemotherapy WOUND DESCRIPTION Location: Length: cm x Width: cm x Depth: cm Undermining Details if applicable: Tunneling Details if applicable: Note: NPWT will continue to be assessed in the comm unity, and settings may be reviewed based on exudate and patient tolerance. Co ntinu atio n o f N PW T i s d […]

Negative Pressure Wound Therapy (NPWT) Referral Form – English

[…] Medium (14.7 cm x 17.4 cm x 1.75 cm) CONVENTIONALbDRESSINGbORDERS Patients will be started on conventional dressings until NPWT can be initiated. Conventional orders a lso required in the case ob service interruption. Negative Pressure Wound Therapy (NPWT) Referral Form NPWT Referral Form 10 June 2024 Page 2 of 2 (Patient Last Name, First […]

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