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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 […]

[…] __________ 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 – […]

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 […]

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 […]

[…] __________ 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 – […]

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 […]

[…] ________________ 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 […]