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Enteral Feeding Form, Jan 2020

Last Updated: 2020 -01 -13 Page 1 Enteral Feed Order Form Section 1: Patient Demographics Name: Address: City: Postal Code: Date: BRN: Phone: Section 2: Tube Details Type of Tube: □ Nasogastric □ Percutaneous Endoscopic Gastrostomy (PEG) □ Percutaneous Endoscopic Gastrojejunostomy (PEG-J) ☐ Jejunostomy Date of Insertion: Physician who inserted the Tube: Plan for Tube […]

Diabetes Type 1 Request Treatment_Form

[…] TREATMENT ORDER FORM DIAGNOSIS : Type 1 Diabetes Pl anned Start Date : REASON FOR REFERRAL TO LHIN: Child/teen requires school support over the lunch hour with: in su lin administration blood glucose monitoring Tim ing: _______________________________________________________________________ Chil d/teen and family to return to Children’s Hospital for ongoing diabetes education and support. If que […]

Diabetes Type 1 Request Treatment_Form

[…] TREATMENT ORDER FORM DIAGNOSIS : Type 1 Diabetes Pl anned Start Date : REASON FOR REFERRAL TO LHIN: Child/teen requires school support over the lunch hour with: in su lin administration blood glucose monitoring Tim ing: _______________________________________________________________________ Chil d/teen and family to return to Children’s Hospital for ongoing diabetes education and support. If que […]

HOOPP Beneficiary Designate Form

[…] hereby designate the person(s) and/or entity(s) set out above as my HOOPP beneficiary(s). I acknowledge that personal information on this form is being collected, used and maintained in order for HOOPP to provide pension services. I understand that personal information may be disclosed to third parties under contract with HOOPP to complete these services. […]

HOOPP Beneficiary Designate Form

[…] hereby designate the person(s) and/or entity(s) set out above as my HOOPP beneficiary(s). I acknowledge that personal information on this form is being collected, used and maintained in order for HOOPP to provide pension services. I understand that personal information may be disclosed to third parties under contract with HOOPP to complete these services. […]

CW-Central-Region-Temporary-Remote-Work-Policy

[…] is not feasible. 2. Scope This policy applies to all Central Region teams and employees. For greater clarity, this includes employees who have transferred to Ontario Health in December 2019 and all employees of: Central, Central West, Mississauga Halton and North Simcoe Muskoka LHINs. 2 This policy is not intended to contravene any collective […]

CW-Central-Region-Temporary-Remote-Work-Policy

[…] is not feasible. 2. Scope This policy applies to all Central Region teams and employees. For greater clarity, this includes employees who have transferred to Ontario Health in December 2019 and all employees of: Central, Central West, Mississauga Halton and North Simcoe Muskoka LHINs. 2 This policy is not intended to contravene any collective […]

PCOT Haldimand Norfolk

[…] ☐ Yes ☐ No Clinical Information Primary Diagnosis _______________________________________________________________________ PPS ____________ Secondary Diagnoses / Comorbidities _______________________________________________________________________ Prognosis ☐ Days ☐ Weeks ☐ greater than 3 months DNR in place ☐ Yes ☐ No Main Concern _____________________________________________________________________ _______________________ _________________________________________________________________________________________________________ ______________________________________________________________________________________________________ ___ Nursing Agency and key contact _ ________________________________________________________________________ ___ Attachments: ☐ Medical Summary / Health […]

Hospice Referral Form

[…] Normal or reduced Full or Confusion ñ09 Mainly Sit/Lie hnable to do any Áork Extensive disease Considerable assistance re‹uired Normal or reduced Full or Confusion ð09 Mainly in Bed hnable to do most activity Extensive disease Mainly assistance Normal or reduced Full or DroÁsy =/ – Confusion 309 Totally Bed Bound hnable to do […]

Hospice Referral Form

[…] Normal or reduced Full or Confusion ñ09 Mainly Sit/Lie hnable to do any Áork Extensive disease Considerable assistance re‹uired Normal or reduced Full or Confusion ð09 Mainly in Bed hnable to do most activity Extensive disease Mainly assistance Normal or reduced Full or DroÁsy =/ – Confusion 309 Totally Bed Bound hnable to do […]

HCCSS-Interim-Prorities-Letter-2021-22-FINAL

[…] with the ministry, as appropriate. -3- Mr. Kenneth Joseph (“Joe”) Parker 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 […]

HCCSS-Interim-Prorities-Letter-2021-22-FINAL

[…] with the ministry, as appropriate. -3- Mr. Kenneth Joseph (“Joe”) Parker 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 […]

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