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OHaH-Patient-Bill-Rights-Large-Text-EN

Patient Bill of Rights As a patient, family member, substitute decision maker or caregiver,  you have the right to expect that every Ontario Health atHome  employee, Board member and contracted health service provider  shall respect and promote your rights as follows: 1. To be dealt with in a respectful manner and to be free from  physical, sexual, mental, emotional, verbal and fnancial abuse. 2. To be dealt with in a manner that respects your dignity and privacy,  and that promotes your autonomy and participation in  decision-making. 3. To be dealt with in a manner that recognizes your individuality and that is sensitive to and responds to your  needs and preferences, including preferences based on ethnic,  spiritual, linguistic, familial and cultural factors. 4. To receive home and […]

OHaH-Patient-Bill-Rights-Large-Text-EN

Patient Bill of Rights As a patient, family member, substitute decision maker or caregiver,  you have the right to expect that every Ontario Health atHome  employee, Board member and contracted health service provider  shall respect and promote your rights as follows: 1. To be dealt with in a respectful manner and to be free from  physical, sexual, mental, emotional, verbal and fnancial abuse. 2. To be dealt with in a manner that respects your dignity and privacy,  and that promotes your autonomy and participation in  decision-making. 3. To be dealt with in a manner that recognizes your individuality and that is sensitive to and responds to your  needs and preferences, including preferences based on ethnic,  spiritual, linguistic, familial and cultural factors. 4. To receive home and […]

COVID-19 Remote Self-Monitoring Program Referral Form 2021 04

[…] for COVID-19 Patient has access to smartphone or other device t hat can run apps COVID-19 Positive How would the patient like to receive notification to participate in the program? (Choose one) By Email By Secure Text Patient to self-isolate at home Patient to self-isolate via cohorting space Patient does not own a smart […]

Adult Intravenous Remdesivir Infusion Therapy Order Form – English

[…] completed copy of this form. Refer to product monograph for specifc details related to lab values and contraindications for infusion. Please complet e the referra l form in its e ntirety and fax completed form to Ontar io Health atHo me at 1-519-472-4045 or 1-855-223-2847 Orders are processed between 8am 8pm (7days/week) and require […]

CH-Referral-Form-EN

[…] Valid OHIP card; Assessment by a Health Care Professional. If faxed, include Number of Pages (Including Cover): Pages Confidential when completed. If you have received this form in error, please ca ll 1.800 .538 .0520. (dd-mm-yyyy) (dd-mm-yyyy) 2.25 (23/0 2) Page 2 of 2 Referral – Primary Care Addendum Last Name, First name: HCN: […]

Referral Form for Community Referrals – English

[…] card; Assessment by a Health Care Professional. If f axed , include Number of Pages (Including Cover): Pages Confidential when completed. If you have received this form in error, please ca ll 1. 800 . 538 . 0520. (dd-mm-yyyy) (dd-mm-yyyy) 2.25 (23/02) Page 2 of 2 Referral – Primary Care Addendum Last Name, First […]

MH-Referral-form-EN

[…] Physician orders weightbearing, ROM or Functional Restrictions, please include all d etails below. Note: To ensure patient safety and care continuity, pleas e complete this Referral Form in full. Palliative referrals are to use the Palliati ve Care Services Referral Form available at healthcareathome.ca When completing Referral: 1.Identify reason/need for each service selected 2.Provide […]

Referral Form – English

[…] If Physician orders weightbearing, ROM or Functional Restrictions, please include all details below. Note: To ensure patient safety and care continuity, please comp lete this Referral Form in full. Palliative referrals are to use the Palliative Care Services Referral Form av ailable at healthcareathome.ca When completing Referral: 1. Identify reason/need for each service selected […]

tc-adult-slp-referral-form-en

[…] hours a day, 7 days a week, every day of the year June 28 20 24, Form /CS-F45 CONFIDENTIAL WHEN COMPLETED. IF YOU HAVE RECEIVED THIS FORM IN ERROR PLEASE DO NOT COPY OR DISPOSE OF CONTACT 416 -506-9 888 AND WE WILL MAKE ARRANGEMENTS TO COLLECT IT. 250 Dundas Street West, Suite 305, […]

tc-adult-slp-referral-form-en

[…] hours a day, 7 days a week, every day of the year June 28 2024, Form /CS -F45 CONFIDENTIAL WHEN COMPLETED. IF YOU HAVE RECEIVED THIS FORM IN ERROR PLEASE DO NOT COPY OR DISPOSE OF CONTACT 416 -506 -9888 AND WE WILL MAKE ARRANGEMENTS TO COLLECT IT. 250 Dundas Street West, Suite 305, […]

cen-palliative-registry-referral-form-en

[…] complete a Medical Referral Form. Ontario Health atHome Palliative Patient Registry supports patients who benefit from a palliative approach to care. Suitable patients are those who are in the end stage of a life limiting illness. Once admitted to the Palliative Patient Registry, individuals will be regularly assessed, supported and linked to palliative resources […]

cen-covid19-remote-self-monitor-referral-form-en

[…] Investigation for bOVID-19 Patient has access to smartphone or other device that can run apps bOVID-19 Positive How would the patient like to receive notification to participate in the program? (bhoose one) By Email By Secure Text Patient to self-isolate at home Patient to self-isolate via cohorting space Patient does not own a smart […]

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