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Palliative Care – Community Services Assessment Request
[…] Services Assessment Request Important Instructions • Referrals without sufcient information will be returned to the referra l source with further direction. • Responsibility for medical care will remain with the primary care pr ovider unless otherwise notifed. • Hospital referrers, please contact the Ontario Health atHome hospital care coordinator prior to discharge for an assessment to inform service planning. Please complete the referral form in its entirety and fax completed form to Ontario Health atHome : 51 9-472-3257 ** The referral will be triaged based on the information provided in this form ** Attach relevant documents to support this referral (e.g. consult notes, current medication list, imaging results, etc.) Patient Information Surname First Name Date of Birth (DD-Month-YYYY) Home Address CityPostal Code Health Card Number Version Code Phone Number Does the patient prefer/need an alternate contact? If yes, indicate in th e Alternate Contact Information section. Assigned sex at birth No Ye s Male Female Gender Identity Male Female Non-Binary Transgender Female Transgender Male […]
ESC-Basic-Wound-Care-Kit-EN
[…] twice a day or your wound is very large, you may need different supplies. Please call your Care Coordinator. Contact Information If you have any questions regarding this service, please contact: 310-2222 • ontariohealthathome.ca Seek URGENT (same day) medical attention from your family doctor or nurse practitioner, or go to the emergency department if […]
Basic Wound Care Kit – English
[…] twice a day or your wound is very large, you may need different supplies. Please call your Care Coordinator. Contact Information If you have any questions regarding this service, please contact: 310-2222 • ontariohealthathome.ca Seek URGENT (same day) medical attention from your family doctor or nurse practitioner, or go to the emergency department if […]
OHaH-Family-Managed-Home-Care-Fact-Sheet-EN
[…] providers in the hom e, including establishing contingency plans. z Able to fully understand and carry out the responsibilities of being an employer, often of multiple care providers. z Capable of managing the fnancial aspects of the program, including the bank account, payment of care providers/agency and taxes, securing insurance, record-keeping and fulflling Ontario Health atHome’s reporting requirements. z Able to use a computer, spreadsheet, scanner, send and receive emails with attachments, name computer fles and enter billing and invoice information in the manner and method requested by Ontario Health atHome (e.g., can be by email or through an online portal). Other Information z The hours and services in the care plan are to be followed with the exception of unexpected changes in health care needs. Patients in this program cannot have more services than what is outlined in their care plan; a guiding principle of the FMHC program is that there is equity between traditional home care and Family- Managed Home Care. z Funding covers the cost of care. z Ontario Health atHome establishes patient reporting requirements and payment schedules. z A legal agreement outlining responsibilities must be signed by the patient and/or their SDM, and Ontario Health atHome. z Ontario Health atHome will reassess the patient’s care needs regularly, as per the normal practice under traditional home care. z Patients or SDMs will continue to collaborate […]
Family Managed Home Care – Fact Sheet – English
[…] providers in the hom e, including establishing contingency plans. z Able to fully understand and carry out the responsibilities of being an employer, often of multiple care providers. z Capable of managing the fnancial aspects of the program, including the bank account, payment of care providers/agency and taxes, securing insurance, record-keeping and fulflling Ontario Health atHome’s reporting requirements. z Able to use a computer, spreadsheet, scanner, send and receive emails with attachments, name computer fles and enter billing and invoice information in the manner and method requested by Ontario Health atHome (e.g., can be by email or through an online portal). Other Information z The hours and services in the care plan are to be followed with the exception of unexpected changes in health care needs. Patients in this program cannot have more services than what is outlined in their care plan; a guiding principle of the FMHC program is that there is equity between traditional home care and Family- Managed Home Care. z Funding covers the cost of care. z Ontario Health atHome establishes patient reporting requirements and payment schedules. z A legal agreement outlining responsibilities must be signed by the patient and/or their SDM, and Ontario Health atHome. z Ontario Health atHome will reassess the patient’s care needs regularly, as per the normal practice under traditional home care. z Patients or SDMs will continue to collaborate […]
CE-Wound-Care-Program-Partner-Information-Sheet-EN
07-2024 Wound Care Program Integrated Skin and Wound Care in the Central East Area Ontario Health atHome advocates and leads an integrated, evidence -informed Wound Care program that spans the continuum of care and drives improvement in the outcomes for people with skin and wound care issues in the Central East area. In collaboration […]
Wound Care Program – Partner Information Sheet – English
07-2024 Wound Care Program Integrated Skin and Wound Care in the Central East Area Ontario Health atHome advocates and leads an integrated, evidence -informed Wound Care program that spans the continuum of care and drives improvement in the outcomes for people with skin and wound care issues in the Central East area. In collaboration […]
Negative Pressure Wound Therapy (NPWT) Referral Form – English
[…] (NPWT) Referral Form NPWT Referral Form 10 June 2024 Page 2 of 2 (Patient Last Name, First Name) BRN: PRECAUTIONS AND CONTRAINDICATIONS The precautions and contraindications listed below have been reviewed, and its determined that NPWT is appropriate to be used for patient Yes No (conventional dressings will be utilized until add ressed) The […]
CH-Infusion-Therapy-IV-Venous-Access-Care-Referral-Form
[…] this form in error, please call 1.800.538.0520. 2.24 .2 (2022/03) COMMUNITY PROTOCOLS APPLICABLE TO ALL ORDERS INDICATED ON PAGE 1 , UNLESS OTHERWISE STATED The community protocols below are based on best practice. • C & S of IV site will be done with a physician’s order and completed lab requisition. A swab will […]
Infusion Therapy Venous Access Care Referral Form – English
[…] f or m in error, please call 1.800.538.0520. 2.24.2 (2022/03) COMMUNITY PROTOCOLS APPLICABLE TO ALL ORDERS INDICATED ON PAGE 1 , UNLESS OTHERWISE STATED The community protocols below are based on best practice. ⢠C & S of IV site will be done with a physicianâs order and completed lab requisition. A swab will […]
CH-Medical-Referral-Form-EN
[…] We pr ocess only complete d re ferrals (signed, date d and legible). Confidential when completed. Fax completed form to 613. 745.6984 or 1.855.450.8569. If you received this form in error, please call 1.800.538.0520. 2.24 (2022/03) PROCE DURES WILL BE TAUGHT TO PATIENT OR RELIABLE PERSON When appropriate, patient are referred to Community Nursing […]
Medical Referral Form – English
[…] We pr ocess only complete d re ferrals (signed, date d and legible). Confidential when completed. Fax completed form to 613. 745.6984 or 1.855.450.8569. If you received this form in error, please call 1.800.538.0520. 2.24 (2022/03) PROCE DURES WILL BE TAUGHT TO PATIENT OR RELIABLE PERSON When appropriate, patient are referred to Community Nursing […]