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Palliative Nurse Practitioner Referral Form

[…] walk-in medical clinic. There are multiple locations across the South West that provide quality nursing care. All sites are accessible and most have free parking. View this online map of South West Community Nursing Clinics. Clinic hours of operation vary by location to best meet the needs of patients in their community. Community Nursing […]

[…] Home Address: CLINICAL INFORMATION Diagnosis: MAID PROGRESS ( please check all that apply) ☐ The patient has received high level information about MAID (what is MAID, steps in process etc.) ☐The patient has received a Form A Patient Request Form and instructions on how to fill it out ☐ The patient has completed a […]

[…] Support Services (HCCSS) organizations , as may be applicable to my role, I may have access to confidential information required for my job , which may be in hard copy, electronic or verbal format. 2. I acknowledge that this agreement encompasses, but is not limited to, the following:  Personal Health Information as defined […]

[…] Support Services (HCCSS) organizations , as may be applicable to my role, I may have access to confidential information required for my job , which may be in hard copy, electronic or verbal format. 2. I acknowledge that this agreement encompasses, but is not limited to, the following:  Personal Health Information as defined […]

[…] of data work and data sharing with the ministry, as appropriate. 6. Digital Delivery and Customer Service • Exploring and implementing digitization or digital modernization strategies for online service delivery and continuing to meet and exceed customer service standards through transition; and • Adopting digital approaches, such as user research, agile development, and product […]

[…] of data work and data sharing with the ministry, as appropriate. 6. Digital Delivery and Customer Service • Exploring and implementing digitization or digital modernization strategies for online service delivery and continuing to meet and exceed customer service standards through transition; and • Adopting digital approaches, such as user research, agile development, and product […]

[…] First Nations Status Yes No Home Address ___ City _____ Postal Code: ____ HCN ___________________________ VC ________ DOB ____________ Family Physician ________________ Psychiatrist ______ _____ Student is in the Care of Children’s Aid Society (Child’s Aid Society is student’s legal guardian) Languages Spoken in Home English French Other Specify Parent/Guardian Contact Information Mother Father […]

[…] 8569 Referral for: ☐ R emote Monitoring COPD ☐ Rem ote Monitoring Heart Failure ☐ Rem ote Monitoring COVID – 19 ☐ Remote Monitoring Diabetes ☐ Enhanced In – Home Remote Monitoring COPD Pilot with Hôpital Montfort ☐ Enhanced In – Home Remote Monitoring Heart Failure Pilot with Hôpital Montfort ☐ Enhanced In – […]

[…] Support Services (HCCSS) organizations , as may be applicable to my role, I may have access to confidential information required for my job , which may be in hard copy, electronic or verbal format. 2. I acknowledge that this agreement encompasses, but is not limited to, the following:  Personal Health Information as defined […]

[…] Residential Program (Waterloo-Wellington) 519 -576 -7431 • 8 6 6 -797-7431 TorchLight Distress Line 519-821-3760 • 888-821-3760 Where to get support & resources togetherall.com/en-ca is a safe, online community where people support each other anonymously to improve mental health and wellbeing. bouncebackontario.ca 866 -345- 0224 Free skill-building program to manage symptoms of depression and […]