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NOTE: The information contained in this form is confi dential. It contains personal health information that is subject to the provisions of the ‘Personal Health Information Protection Act, 2004’. This form and its contents should not be distributed, copied or disclosed to any unauthorized persons. If you have accessed this form in error, please […]

Note:  The information contained  in this form is confidential. It c ontains personal health information that is subject to the provisions of the ‘Personal Health Information  Protection Act, 2004’. This form and its contents should not  be distributed, copied or disclosed to any unauthorized persons. If you have accessed this form in error,  please contact the owner or sender immediately.  V 3.9  C O PD & H eart F ailure T elehom ecare R eferral F orm Pleas e fa x re fe rra l for ms(s ) to :  PATIENT INFORMATION  Referral Date ( D D MM YYYY) :  ________________   LAST NAME F IRST NAME DATE OF BIRTH (DD MM YYYY) HEALTH CARD […]

Ontario Health atHome, Request for Release of Personal Health Information

[…] Nursing Nutritional Services Occupational Therapy Personal Support (e.g. bathing, dressing) Physiotherapy Social Work Speech Lanuage Pathology Community Linking (e.g. housekeeping, shopping, tra nsportation) Has the patient been in the ER/hospital within the last 14 days? Unknown No Yes Does the patient have a current cancer diagnosis? Unknown No Yes Has the patient had any […]

Community Clinic Eligibility Criteria 18 June 2021 Page 1 of 1 Community Clinic vs. In-Home Nursing Eligibility Information to guide patient-focused decisions Clinic Eligibility With extended evening and weekend hours, and seven convenient locations to choose from, for most patients Ontario Health atHome community clinics are the best options to ensure high-quality, specialized nursing […]

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