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NE-mental-health-addictions-services-referral

HOME AND COMMUNITY CARE SUPPORT SERVICES North East REFERRAL FOR MENTAL HEALTH AND ADDICTION S NURSING ( MHAN) Version 1 ( 29/03/2021) Page 1 of 1 Student’s Last Name: Student’s First Name: Gender: Mal e Female Date of Bi rth ( DD/ MM/ YYYY) : Health Card Number: Contact Number: Home Address: Ap artment #: […]

NE-mental-health-addictions-services-referral

REFERRAL FOR MENTAL HEALTH AND ADDICTION S NURSING ( MHAN) Vers ion 2 (J une 28, 2024) Page 1 of 1 Student’s Last Name: Student’s First Name: Gender: Mal e Female Date of Bi rth ( DD/ MM/ YYYY) : Health Card Number: Contact Number: Home Address: Ap artment #: City: Provi nce : ON […]

HCCSS-2013-11-01-Appendix-B

CCAC-S erv ice P rov id er R ela ti ons FR AME WOR K Appendix B Oc to b er 29, 2 00 9 – D RAFT 4 CC AC-Service Provider Rela tions Fram ew ork 29Oct09 2 CCAC-S ER VICE P R O VID ER R ELA TIO N S F R AM […]

HCCSS-2013-11-01-Appendix-B

CCAC-S erv ice P rov id er R ela ti ons FR AME WOR K Appendix B Oc to b er 29, 2 00 9 – D RAFT 4 CC AC-Service Provider Rela tions Fram ew ork 29Oct09 2 CCAC-S ER VICE P R O VID ER R ELA TIO N S F R AM […]

NE-referral-home-and-community-care-services-additional-notes

REFERRAL FOR SERVICES – ADDITIONAL NOTES Fax to: Kirkland Lake North Bay Parry Sound Sault Ste. Marie Sudbury Timmins 705 567 9407 705 474 0080 1 855 773 4056 705 949 1663 705 522 3855 705 267 7795 Version 1 (29/03/2021 ) Page 1 of 1 Additional Notes re lating to the attached Referral for […]

NE-referral-home-and-community-care-services-additional-notes

REFERRAL FOR SERVICES – ADDITIONAL NOTES Fax to: Kirkland Lake North Bay Parry Sound Sault Ste. Marie Sudbury Timmins 705 567 9407 705 474 0080 1 855 773 4056 705 949 1663 705 522 3855 705 267 7795 Version 2 (June 28, 2024 ) Page 1 of 1 Additional Notes re lating to the attached […]

NE-referral-for-services-medication-list

NOTE: A current m edication list is recommended with each referral. You may use this form or provide a c urr ent medication list using your own agency-specific/primary care provider ’s form if it contains the following information: Version 1 (29/03/2021) Page of1 1 Patient’s Last Name: First Name: Date of Birth (DD/MM/YYYY): Health Card: […]

NE-referral-for-services-medication-list

NOTE: A current m edication list is recommended with each referral. You may use this form or provide a c urr ent medication list using your own agency-specific/primary care provider ’s form if it contains the following information: Version 1 (29/03/2021) Page of1 1 Patient’s Last Name: First Name: Date of Birth (DD/MM/YYYY): Health Card: […]

NE-referral-cvad-through-cancer-program

REFERRAL FOR CENTRAL VENOUS ACCESS DEVICE (CVAD) THROUGH REGIONAL CANCER PROGRAM Version 1 (29/03/2021) Page 1 of 1 DEMOGRAPHICS Health Card Number: Version Code: Date of Birth (DD/MM/YYYY): Surname: First name(s): Address: City: Province: Postal Code: Phone #: Primary language: English French Other (specify): Gender: Male Female Undifferentiated Unknown Weight (kg): He ight (cm): Name […]

NE-referral-cvad-through-cancer-program

REFERRAL FOR CENTRAL VENOUS ACCESS DEVICE (CVAD) THROUGH REGIONAL CANCER PROGRAM Version 2 (June 28, 2024) Page 1 of 1 DEMOGRAPHICS Health Card Number: Version Code: Date of Birth (DD/MM/YYYY): Surname: First name(s): Address: City: Province: Postal Code: Phone #: Primary language: English French Other (specify): Gender: Male Female Undifferentiated Unknown Weight (kg): He ight […]

HCCSS-Service-Providers-Sale-of-Business-Process

Notice from SPO re : Selling / Buying Process LHIN to provide SPO the Sale of Business guidelines and advise the SPO that HSSOntario will coordinate Sale of Business process HSSOntario leads due diligence process including procurement of financial advice as necessary Legal Counsel for the LHINs and LHIN Contract Managers meets to review the […]

Hospice Referral Form

Residence Bed ☐ Day Program ☐ Outreach Team ☐ Visiting Volunteer ☐ Bereavement ☐ Psychosocial Spiritual Hospice Referral Form ☐      Hospice Emmanuel House Carpenter House Hospice Niagara McNally House Bob Kemp Stedman Margaret’s Place Fax # 905-308-8 116 905-631-7 107 905-646-3 860 905-309-6 656 905-318-8 411 519-751-7 527 905-627-6577 Patient […]