Diabetes Type 1 Request Treatment Form
Diabetes Type 1 Request Treatment Form
Long Term Care Home Short Stay Interim Choice List – Francais
[…] (Last Name, First Name) Health Card No. Version Code Please select up to five long – term care homes (LTCHs) for short stay interim, and rank them in order of your preference. The applicant’s name will be added to the wait lists for the chosen homes if eligible, and if the chosen LTCHs can […]
[…] : Health Card Number: DOB : Address: CONTINUOUS AMBULATORY DELIVERY DEVICE PATIENT CONTROLLED ANALGESIA (CADD SOLIS – PCA) PRESCRIPTION / ORDER DIAGNOSIS: ALLERGIES: No Yes Please list: In the event of anaphylaxis, community nursing service provider will follow their specific agency policy. PRESCRIPTION/ORDERS CADD Solis PCA Prescription/Orders Route: (Check one) Subcutaneous (S.C) Port-a-cath (PAC) […]
[…] : Health Card Number: DOB : Address: CONTINUOUS AMBULATORY DELIVERY DEVICE PATIENT CONTROLLED ANALGESIA (CADD SOLIS – PCA) PRESCRIPTION / ORDER DIAGNOSIS: ALLERGIES: No Yes Please list: In the event of anaphylaxis, community nursing service provider will follow their specific agency policy. PRESCRIPTION/ORDERS CADD Solis PCA Prescription/Orders Route: (Check one) Subcutaneous (S.C) Port-a-cath (PAC) […]
Referral form for administering COVID-19 antivirals in South East community nursing clinics.
[…] confidential. Any other delivery, distribution, copying or disc losure is strictly prohibited and is not a waiver of privilege or confidentiality. If you have received this telecommunication in e rror, please notify the sender immediately by telephone at 721 -8010 or 1 -888 -721 – 2222 so that arrangements can be made for its […]
[…] Type(s) of Services Requested Community Palliative Care Providers Services Check if appropriate and select appropriate referral Community Hospice Services Check if appropriate and enter details Medical Assistance in Dying (MAiD) Check if appropriate and select appropriate option Ontario Health atHome Check if appropriate and select all appropriate services Pain and Symptom Manageme nt Check […]
[…] Type(s) of Services Requested Community Palliative Care Providers Services Check if appropriate and select appropriate referral Community Hospice Services Check if appropriate and enter details Medical Assistance in Dying (MAiD) Check if appropriate and select appropriate option Ontario Health atHome Check if appropriate and select all appropriate services Pain and Symptom Manageme nt Check […]
[…] to Home and Community Care Support Services: ■ Speak with our Hospital Care Coordinators ■ Call us at 310-2222 (no area code required), or ■ Complete our online medical referral form or request an assessment form SE Health 11 Lakeside Terrace, Suite 101 Barrie , ON L4M 0H9 Phone: 705-737-5055 Bayshore Home Care Solutions […]
[…] to Home and Community Care Support Services: ■ Speak with our Hospital Care Coordinators ■ Call us at 310-2222 (no area code required), or ■ Complete our online medical referral form or request an assessment form SE Health 11 Lakeside Terrace, Suite 101 Barrie , ON L4M 0H9 Phone: 705-737-5055 Bayshore Home Care Solutions […]
