Adult Day Programs provide fun, engaging activities in the community for people with physical or cognitive challenges, as well as those with Alzheimer’s disease and related dementias. There are 10 Adult Day Programs at 17 locations in the Home and Community Care Support Services Mississauga Halton region. Check out our brochure to see a […]
Last Updated: 2022-0 9-23 Page 1 Enteral Feed Order Form Section 1: Patient Demographics Name: Address: City: Postal Code: Date: BRN: Phone: Section 2: Tube Details Type of Tube: â¡Nasogastric â¡ Percutaneous Endoscopic Gastrostomy (PEG) â¡ Percutaneous Endoscopic Gastrojejunostomy (PEG-J) â Jejunostomy Date of Insertion: Physician who inserted the Tube: Plan for Tube Replacement: Section […]
REQUEST AND TREATMENT ORDER FORM DIAGNOSIS : Type 1 Diabetes Plan ned Start Date : REASON FOR REFERRAL: Child/teen requires school support over the lunch hour with: in sulin administration blood glucose monitoring Timi ng: _______________________________________________________________________ Child /teen and family to return to Children’s Hospital for ongoing diabetes education and support. If ques tions […]
Last Updated: 2022/09/23 Page 1 of 1 Palliative Patient Status UpdateNAME: ADDRESS: CASELOAD: HCN/BRN: DATE d/m/ y : ATTENTION: PPS %:_ Pain scale : /10 Current Pain Regime: Areas of Concern: Suggestion of Treatment Orders: Additional Information: SIGNATURE: DESIGNATION: AGENCY PHONE NUMBER: RESPONSE OR ORDERS Response Required: YES NOSouth West Home and Community […]
Last Updated: 2022/09/23 Page 1 of 1 Palliative Patient Status UpdateNAME: ADDRESS: CASELOAD: HCN/BRN: DATE d/m/ y : ATTENTION: PPS %:_ Pain scale : /10 Current Pain Regime: Areas of Concern: Suggestion of Treatment Orders: Additional Information: SIGNATURE: DESIGNATION: AGENCY PHONE NUMBER: RESPONSE OR ORDERS Response Required: YES NOSouth West Home and Community […]
Last Updated: 2022/09/23 Page 1 of 1 Palliative Patient Status UpdateNAME: ADDRESS: CASELOAD: HCN/BRN: DATE d/m/ y : ATTENTION: PPS %:_ Pain scale : /10 Current Pain Regime: Areas of Concern: Suggestion of Treatment Orders: Additional Information: SIGNATURE: DESIGNATION: AGENCY PHONE NUMBER: RESPONSE OR ORDERS Response Required: YES NOSouth West Home and Community […]
Last Updated: 2022/09/23 Page 1 of 1 Palliative Patient Status UpdateNAME: ADDRESS: CASELOAD: HCN/BRN: DATE d/m/ y : ATTENTION: PPS %:_ Pain scale : /10 Current Pain Regime: Areas of Concern: Suggestion of Treatment Orders: Additional Information: SIGNATURE: DESIGNATION: AGENCY PHONE NUMBER: RESPONSE OR ORDERS Response Required: YES NOSouth West Home and Community […]
Adult Day Programs provide fun, engaging activities in the community for people with physical or cognitive challenges, as well as those with Alzheimer’s disease and related dementias. There are 10 Adult Day Programs at 17 locations in the Home and Community Care Support Services Mississauga Halton region. Check out our brochure to see a […]
Last Updated: 2018 02 01 Page 1 Palliative Patient Status Update NAME: ADDRESS: CASELOAD: HCN/BRN: DATE d/m/ y : ATTENTION: PPS %:_ Pain scale : /10 Current Pain Regime: Areas of Concern: Suggestion of Treatment Orders: Additional Information: SIGNATURE: DESIGNATION: AGENCY PHONE NUMBER: RESPONSE OR ORDERS Response Required: YES NO South West LHIN […]
Last Updated: 2020 -01 -13 Page 1 Enteral Feed Order Form Section 1: Patient Demographics Name: Address: City: Postal Code: Date: BRN: Phone: Section 2: Tube Details Type of Tube: â¡ Nasogastric â¡ Percutaneous Endoscopic Gastrostomy (PEG) â¡ Percutaneous Endoscopic Gastrojejunostomy (PEG-J) â Jejunostomy Date of Insertion: Physician who inserted the Tube: Plan for Tube […]
Patient Name: D.O.B.: Address: Allergies: Phone # Health Card # Delivery or Pick Up MD or NP NOTIFIED DATE KIT INITIATED: SIGNATURE: DATE: Acetaminophen 650mg Supp. Refill x 2Mitte: 5 Suppositories Sig: Insert 1 suppository rectally Q4H PRN for temperature over 101 F (38.5 C) Metoclopramide 10mg/2ml LU481 ( pseudo DIN 09857224) Refill x 2Mitte: […]
[…] offer you an app ointment with a regulated health care professional (Assessor). What do I need to do before my appointment? Plan to spend about one hour in the clinic. To optimize your time with your Assessor, please ensure you have: A valid health card; Access to your x-rays (e.g., on a […]
