Request for HCCSS HNHB services
[…] __________ Address: _____________________________________________ Phone Home: _________________Cell: ____________________ Address & Phone for IV delivery & C are Provision (if different) _____________________________________________________ _____________________________________________________ _____________________________________________________ Referral Form must be completed in full to permit processing. Incomplete o rders will be returned . Co mplete & fax to: 1-5 19-472-4045 or 1-8 55-223-2847 Orders processed between 8am – […]
Enteral Feeding Order Form – Adult
Enteral Feeding Order Form – Adult
Déclaration des droits du patient : Gros caractères – Français
[…] Care Support Services employee, Board member and contracted health service provider shall respect and promote your rights as follows: Page 1 of 2 To be dealt with in a respectful manner and to be free from physical, sexual, mental, emotional, verbal and financial abuse. To be dealt with in a manner that respects your […]
[…] ________________ Cell Phone: __________________________________ _____ HCN: _______________________________ VC: _____ _____ DOB (dd/mm/yy) : _____________ ____________________ Family Physician: _________________ ____________ __ Out -patient Psychiatrist: _______________________ ____________ Student is in the Care of Children’s Aid Society (Child’s Aid Society is student’s legal guardian) Protection Agency and Worker: __________________________ ____ Contact: __________________________ ______________ Parent, Guardian or Other […]
[…] reduced Full or Confusion ☐ 50% Mainly Sit/Lie Unable to do any work Extensive disease Considerable assistance required Normal or reduced Full or Confusion ☐ 40% Mainly in Bed Unable to do most activity Extensive disease Mainly assistance Normal or reduced Full or Drowsy +/- Confusion ☐ 30% Totally Bed Bound Unable to do […]
[…] reduced Full or Confusion ☐ 50% Mainly Sit/Lie Unable to do any work Extensive disease Considerable assistance required Normal or reduced Full or Confusion ☐ 40% Mainly in Bed Unable to do most activity Extensive disease Mainly assistance Normal or reduced Full or Drowsy +/- Confusion ☐ 30% Totally Bed Bound Unable to do […]
[…] reduced Full or Confusion ☐ 50% Mainly Sit/Lie Unable to do any work Extensive disease Considerable assistance required Normal or reduced Full or Confusion ☐ 40% Mainly in Bed Unable to do most activity Extensive disease Mainly assistance Normal or reduced Full or Drowsy +/- Confusion ☐ 30% Totally Bed Bound Unable to do […]
[…] reduced Full or Confusion ☐ 50% Mainly Sit/Lie Unable to do any work Extensive disease Considerable assistance required Normal or reduced Full or Confusion ☐ 40% Mainly in Bed Unable to do most activity Extensive disease Mainly assistance Normal or reduced Full or Drowsy +/- Confusion ☐ 30% Totally Bed Bound Unable to do […]
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