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[…] of 3 PATIENT INFORMATION Name: (Individual’s Last Name, First Name) Home Address: (Street No., Street Name, Building) (Apt/Suite#) (Entry Code) City: Postal Code: Lives Alone Young Children in the Home Smoking in the Home Pet(s) in the Home (Specify): Home Phone Number: Alternate Number: Date of Birth: Gender: Male Faith/Religion: (dd -mmm -yyyy) Female […]

1 Physician use only. Applicable billing as outlined in the Schedule of Benefits for Physician Services under the PS 030a E JN 15 Health Insurance Act. HOME AND COMMUNITY CARE SUPPORT SERVICES ERIE ST. CLAIR SERVICES DE SOUTIEN A DOMICILE ET EN MILIEU COMMUNAUTAIRE D’ÉRIÉ ST-CLAIR Medical Update Request Form – Wound Frequency of […]

[…] exception under section 6.0(d) of the “Client Services Procurement Procedures for Community Care Access Centers, January 2007”, (Procurement procedures document), which allowed the Mississauga Halton LHIN to enter into a non -competitive contract for the provision of Personal Support and Homemaking Services for 24 beds at a local retirement home . These beds continue […]

[…] under section 6.0(d) of the “Client Services Procurement Procedures for Community Care Access Centers, January 2007”, (Procurement procedures doc ument), which allowed the Mississauga Halton LHIN to enter into a non -competitive contract for the provision of Personal Support and Homemaking Services for 24 beds at a local retirement home . Funding for fiscal […]

[…]   ☐ Surgical  Must be open surgical wound  Type of surgery: ☐ Pilonidal sinuses Must be offloaded when  patient is sitting/lying  Indicate pressure relieving devices in use: ☐ Other  State type of wound: Wound Measurements and Description  Length: cm  Width: cm  Depth   cm  Undermining:   Tunneling: Expected therapy goals: Heali n g i n weeks  ☐ Wounds must have the following criteria to be eligible for  eS TIM therapy:  Healable wounds  Wounds that are not healing at the expected rate despite evidence‐based wound care practices.  Surgical wounds.  Leg ulcers with ABPI =/> 0.5  Stage III to IV Pressure Ulcers.  Dehisced wounds.  Diabetic foot ulcers following surgical procedures or sharp debri dement with viable tissue (ABPI =/> 0.5.) No eSTIM therapy contraindications exist (request will be denied if any of these are present):   Failure to treat‐the‐cause of the wound first (pressure – offloading, edema – compression, etc)  […]

[…] 1044 E JA20 1 of 3  Electrical Stimulation (eSTIM) Referral Assessment  Patient Name:  BRN: Address:  Date of Birth: Date:  AGE OF WOUND:  Physician/Wound Care Specialist, please check to indicate type of wound and indicate patient has met eligibility criteria  – Patient must meet eligibility criteria before provision of eSTIM by Ontario Health atHome TYPE OF WOUND  MUST BE COMPLETED FOR ELIGIBILITY ☐ Pressure ulcer  Pressu re must be offloaded  Indicate pressure relieving devices  in use: ☐ Diabetic foot ulcer Patient blood sugar is being  monitored/controlled Wound  must be offloaded  State blood sugar: State offloading device: ☐ Venous leg ulcer  Must be in compression  State type of compression system: ☐ Arterial ulcer ABPI must be =/>0.5 or  vascular assessment  complete  State ABPI: Vascular studies complete  yes   ☐  no   ☐   ☐ Surgical  Must be open surgical wound  Type of surgery: ☐ […]

[…] work closely with family physicians and primary care practitioners to bring you care closer to home. You can register for Health Care Connect by calling 1-800-445-1822, or online at www.health.gov.on.ca. Primary health care providers Specially-trained nurses provide care in our community clinics for patients requiring services such as: • Intravenous therapy (IV) • Wound […]

[…] member, or a friend are facing a life-limiting illness or end-of-life decisions. Our team of professionals form an integral part of your circle of care as you enter this next phase of life. We work closely with your existing supports and professional services, and bring in additional services as needed. Important phone numbers Home […]