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HNHB-Accessible-Customer-Service-Notice-Temp-Disruptions-Services-Facilities-EN
POLICY & PROCEDURE Title Accessible Customer Service – Notice of Temporary Disruptions in Services and Facilities Category Human Resources, Organizational Development & Equity Sub -Category Accessibility Version # 2 Approver V.P. Human Resources, Organizational Development & Equity Owner Director, Human Resources & Organizational Development Date Approved 01/26/2023 Next Review Date 01/26/2026 Once printed, this is […]
HNHB-Accessible-Customer-Service-Notice-Temp-Disruptions-Services-Facilities-EN
POLICY & PROCEDURE Title Accessible Customer Service – Notice of Temporary Disruptions in Services and Facilities Category Human Resources, Organizational Development & Equity Sub -Category Accessibility Version # 2 Approver V.P. Human Resources, Organizational Development & Equity Owner Director, Human Resources & Organizational Development Date Approved 01/26/2023 Next Review Date 01/26/2026 Once printed, this is […]
SW-IV-Antibiotic-Referral-Form
= IV Ant ibiot ic Referral Order Form Last Updated: 2022-09-23 Page 1 To consult a Community Phar macist : Yureks Specialties Limited (London, Middlesex, Oxford, Elgin & South Huron) Phone: 1 – 519-680- 7474, Ext: 5404 Browns Pharmacy (Grey Bruce, North Huron/Perth ) Phone: 1-519 -881 -2420 or 1-844 -474 -7577 PRESCRIBER (PLEASE PRINT […]
Request for HCCSS HNHB services
Version 23-001 Request for Home and Community Care Support Services Hamilton Niagara Haldimand Brant Patient Name ______________________________________ HCN _________________ VC ______ DOB __________________ Address _______________________________________ City _____________ Province ______ Postal Code _____________ Patient Phone ____________________ Contact Name _________________________ Contact Phone ___________________ ☐ Community: Fax completed form to 1-8 66-655-6 402 ☐ Hospital: Fax completed form […]
Request for HCCSS HNHB services
Version 23-001 Request for Home and Community Care Support Services Hamilton Niagara Haldimand Brant Patient Name ______________________________________ HCN _________________ VC ______ DOB __________________ Address _______________________________________ City _____________ Province ______ Postal Code _____________ Patient Phone ____________________ Contact Name _________________________ Contact Phone ___________________ ☐ Community: Fax completed form to 1-8 66-655-6 402 ☐ Hospital: Fax completed form […]
IV_Antibiotic Referral_Form09-2022_Fillable
= IV Ant ibiot ic Referral Order Form Last Updated: 2022-09-23 Page 1 To consult a Community Phar macist : Yureks Specialties Limited (London, Middlesex, Oxford, Elgin & South Huron) Phone: 1 – 519-680- 7474, Ext: 5404 Browns Pharmacy (Grey Bruce, North Huron/Perth ) Phone: 1-519 -881 -2420 or 1-844 -474 -7577 PRESCRIBER (PLEASE PRINT […]
Enteral Feeding Order Form – Adult
2023JAN23.V001 Page 1 of 2 356 Oxford Street W est London, ON N6H 1T3 Telephone: 1-800 -811 -5146 Fax: 519 -472 -4045 Enteral Feeding Order Form – Adult PATIENT DETAILS Surname First Name Home Address City Postal Code Health Card Number (HCN) Version Code Date of Birth (YYYY -Month -DD) ENTERAL FEEDING TUBE DETAILS Type […]
Enteral Feeding Order Form – Adult
2023JAN23.V001 Page 1 of 2 356 Oxford Street W est London, ON N6H 1T3 Telephone: 1-800 -811 -5146 Fax: 519 -472 -4045 Enteral Feeding Order Form – Adult PATIENT DETAILS Surname First Name Home Address City Postal Code Health Card Number (HCN) Version Code Date of Birth (YYYY -Month -DD) ENTERAL FEEDING TUBE DETAILS Type […]
573 MHAN Referral
MENTAL HEALTH & ADDICTIONS REFERRAL FORM WW573 Sept 23, 2022 Page 1 of 2 Legal name (on HCN): _________________________ _______________ Preferred Name: __ ________________________ _ Gender: Male Female Identify as Other Non – Binary Pronouns used : _______________________ _________ Do you self -identify as having First Nations (status or non -status), Métis, or Inuit ancestry?: […]
Niagara Palliative Care Outreach Team (PCOT) Referral Form – Niagara v4
Niagara Palliative Care Outreach Team Referral Form Phone: 905-98 4-8766 x263 Fax: 905-93 4-9430 Patient Name _________________________________________________ HCN ___________________ VC _____ DOB ____________ Address ______________________________________________ City _______________ Province ______ Postal Code ____________ Patient Phone # ___ ____________________ Preferred Language __ _____________________ Patient Aware of Referral ☐ Yes ☐ No Contact Name __ __________________________________________________ Contact Phone […]
HNHB Palliative Care Outreach Team (PCOT) Referral Form – Niagara
Niagara Palliative Care Outreach Team Referral Form Phone: 905-98 4-8766 x263 Fax: 905-93 4-9430 Patient Name _________________________________________________ HCN ___________________ VC _____ DOB ____________ Address ______________________________________________ City _______________ Province ______ Postal Code ____________ Patient Phone # ___ ____________________ Preferred Language __ _____________________ Patient Aware of Referral ☐ Yes ☐ No Contact Name __ __________________________________________________ Contact Phone […]
Niagara Palliative Care Outreach Team (PCOT) Referral Form
Niagara Palliative Care Outreach Team Referral Form Phone: 905-98 4-8766 x263 Fax: 905-93 4-9430 Patient Name _________________________________________________ HCN ___________________ VC _____ DOB ____________ Address ______________________________________________ City _______________ Province ______ Postal Code ____________ Patient Phone # ___ ____________________ Preferred Language __ _____________________ Patient Aware of Referral ☐ Yes ☐ No Contact Name __ __________________________________________________ Contact Phone […]