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Name : Health Card Number: DOB : Address: CONTINUOUS AMBULATORY DELIVERYDEVICE PATIENT CONTROLLED ANALGESIA (CADD SOLIS –PCA) PRESCRIPTION / ORDER DIAGNOSIS: ALLERGIES: No Yes Please list: In the event of anaphylaxis, community nursingservice provider will followtheir specific agencypolicy. PRESCRIPTION/ORDERS CADD Solis PCA Prescription/Orders Route:(Check one) Subcutaneous (S.C) Port-a-cath (PAC) Drug: Intravenous(I.V) PICC Concentration*: mg/ml Continuous […]

Au sujet de Services de soutien à domicile et en milieu communautaire du Centre Services de soutien à domicile et en milieu c omm unauta ire d u C entre est l’un de 14 organismes e n Ontario do nt le mandat consiste à fournir des s ervices de santé à l’échelle locale, comme des […]

Home and Community Care Support Services (Referral_Updates – Initial_Ref) Central West 1096 Updated: February 10 , 2023 Palliative Nurse Practitioner Referral Form Patient Name: Address: City: Postal Code: Telephone: D.O.B ___/___/___ HCN: VC: DD/MM/YY Patient has consented to Palliative Nurse Practitioner (NP) referral Patient meets Palliative NP Program referral criteria (see page 2 for eligibility […]

Where we provide care is shifting! Community Nursing Clinics ensure that care in the community is provided in a safe manner, while managing the availability of community nurses responsibly. To provide reliable, high-quality care, we take a ‘clinic-first’ approach. We provide clinic-based care to patients who can be appropriately supported in our numerous clinic locations […]

Page 1 of 1 | Last Edited: 2022-03-23 HOME AND COMMUNITY CARE SUPPORT SERVICES SOUTH WEST MAiD REFFERAL Phone: 1 -833- 388-7331 Fax: 1- 833-388-7383 Email: sw.maid@hccontario.ca ☐ MAID referral for someone not currently receiving HCCSS SW services or unknown if they are receiving services ☐ MAID referral for someone currently receiving HCCSS SW services […]

Effective Date : November 2022 Page 1 of 1 Confidentiality Agreement 1. I acknowledge that during my employment or association (e.g. student, consultant, or volunteer) with any and all Home and Community Care Support Services (HCCSS) organizations , as may be applicable to my role, I may have access to confidential information required for my […]

Effective Date : November 2022 Page 1 of 1 Confidentiality Agreement 1. I acknowledge that during my employment or association (e.g. student, consultant, or volunteer) with any and all Home and Community Care Support Services (HCCSS) organizations , as may be applicable to my role, I may have access to confidential information required for my […]

Ministry of Health Office of the Deputy Premier and Minister of Health 777 Bay Street, 5 th Floor Toronto ON M7A 1N3 Telephone: 416 327-4300 Facsimile: 416 326-1571 www.ontario.ca/health Ministère de la Santé Bureau du vice – premier ministre et du ministre de la Santé 777, rue Bay, 5 e étage Toronto ON M7A 1N3 […]

Ministry of Health Office of the Deputy Premier and Minister of Health 777 Bay Street, 5 th Floor Toronto ON M7A 1N3 Telephone: 416 327-4300 Facsimile: 416 326-1571 www.ontario.ca/health Ministère de la Santé Bureau du vice – premier ministre et du ministre de la Santé 777, rue Bay, 5 e étage Toronto ON M7A 1N3 […]

CHILD AND YOUTH M ENTAL HEALTH & ADDICTIONS NURSE (MHAN ) REFERRAL 573 April 2 0, 2 021 Page 1 of 1 Student Information Student’s Name ___ ______ _ Phone ______ Home Cell Gender: Male Female Other Patient identifies as First Nations Status Yes No Home Address ___ City _____ Postal Code: ____ HCN ___________________________ […]