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tc-palliative-care-referral-form-en

[…] Organization’s Release of Information Form, if applicable. Addressograph or Label Individual’s First & Last Name: 2 Home Address: Apt: Entry Code: Postal Code: Lives Alone Young Children in the Home Smoking in the Home Pet in the Home (specify): Home phone number: Alternate number: Date of birth: (DD/MM/YY) Gender: Faith/Religion: Health card number: Version […]

Palliative Care Referral Form – English

[…] Organization’s Release of Information Form, if applicable. Addressograph or Label Individual’s First & Last Name: 2 Home Address: Apt: Entry Code: Postal Code: Lives Alone Young Children in the Home Smoking in the Home Pet in the Home (specify): Home phone number: Alternate number: Date of birth: (DD/MM/YY) Gender: Faith/Religion: Health card number: Version […]

cen-palliative-common-referral-form-en

[…] of 3 PATIENT INFORMATION Name: (Individubl’s Lbst Nbme, First Nbme) Home Address: (Street No., Street Nbme, Building) (Apt/Suite#) (Entry Code) City: Postal Code: Lives Albne Ybung Children in the Hbme Smbking in the Hbme Pet(s) in the Hbme (Specify): Hu.n sbuwn /R.-ng’ evyngw,yn /R.-ng’ Date of Birth: Gender: Male Faith/Religion: (dd -mmm -yyyy) Female […]

cen-palliative-common-referral-form-en

[…] 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 […]

SE-MHAN-Referral-Form

[…] Cell # Bus # Address City Postal Code Other Specify Specify Other Preferred Pronoun s: Home # Cell # Bus # Address City Postal Code Languages Spoken in Home English French Interpreter Required No Yes Consent Information Verbal/Written Consent for Referral Obtained from the Student No Yes Date DD / MM / YY Verbal/Written […]

OHaH-Long-Term-Care-Placement-Guide-EN

[…] Care Homes 5 2. Visit the homes you would like to consider  Visiting homes or learning more  about your top    choices by visiting    Ontario.ca/LongTermCare   will help answer some of your  questions. By taking a tour,  you can get a better feel for the  surroundings and the people who work and live  in the home.   When you visit a long-term care home, you may  want to ask:    z for an information package on the home    z for copies of recent inspection reports – the  province conducts regular inspections, as  required under the Fixing Long-Term Care  Act, 2021. You can also fnd the reports  online  at  publicreporting.ltchomes.net     z to speak to a member of the home’s  Residents’ Council    z to speak to a member of the home’s Family  Council, if available  Before touring the long-term care homes you are  considering, list the features that are important  to you and pre-book the visit so that you will be  able to get an informative tour. Some things to  consider for your list:     z Location:  Is the home close enough for  family and friends to visit?    z Cultural/language/religious preferences:  Do these factors need to be considered?    […]

Long-Term Care Placement Guide – English

[…] Care Homes 5 2. Visit the homes you would like to consider  Visiting homes or learning more  about your top    choices by visiting    Ontario.ca/LongTermCare   will help answer some of your  questions. By taking a tour,  you can get a better feel for the  surroundings and the people who work and live  in the home.   When you visit a long-term care home, you may  want to ask:    z for an information package on the home    z for copies of recent inspection reports – the  province conducts regular inspections, as  required under the Fixing Long-Term Care  Act, 2021. You can also fnd the reports  online  at  publicreporting.ltchomes.net     z to speak to a member of the home’s  Residents’ Council    z to speak to a member of the home’s Family  Council, if available  Before touring the long-term care homes you are  considering, list the features that are important  to you and pre-book the visit so that you will be  able to get an informative tour. Some things to  consider for your list:     z Location:  Is the home close enough for  family and friends to visit?    z Cultural/language/religious preferences:  Do these factors need to be considered?    […]

North Simcoe Muskoka Adult Day Programs – English

[…] subject to change. Addi tional services such as hairdressing and caregiver support are subject to an additional fee. Appointments for tours of the facilities may be made in advance with program staff. The goal is to maintain the patient’s optimum level of intellectual, physical and social capability as well as provide respite and support […]

Referral Assessment Request – English

[…] Patient Aware of Prognosis  Yes  No Allergies Form Instructions Please return this form to Ontario Health atHome via fax. London: 519-472 -4045 ( patients living in London/Middlesex and Elgin) Stratford : 519-273 -2847 or toll free: 1 -855 -223 -2847 ( patients living in Grey/Bruce, Huron, Oxford, Perth) Equipment Orders Height (cm/ […]

People Strategy – 2024-25 – English

[…] Workplace Framework. This will include the development and delivery of wellness resources and programs, including in-person, virtual, self-directed and facilitated options as well as carefully curated, quality online resources and tools. I joined Home and Community Care Support Services because I wanted to contribute my skills and experience as a health care communicator to […]

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