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 […]
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 […]
[…] 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 […]
[…] more ideal to some, Shirley was committed to maintaining her life at home. Once very shy, self -conscious and anxious, with the right connections and proper supports in place she began finding the reassurance she needed in knowing that her voice would be heard and she had a say in the care she received. […]
[…] more ideal to some, Shirley was committed to maintaining her life at home. Once very shy, self -conscious and anxious, with the right connections and proper supports in place she began finding the reassurance she needed in knowing that her voice would be heard and she had a say in the care she received. […]
1 Meilleur système, meilleurs soins Rapport annuel 2017 – 2018 3 PHOTO DE COUVERTURE : La coordonnatrice des soins à domicile et en milieu communautaire du RLISS du Sud – Est, Tina Misevicius (à droite), accompagnée d’une patiente recevant des soins à domicile, Shirley, et de Sarah McParland, coordonnatrice de soins du maillon santé de […]
