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[…] Mat s CC PT OT Nurse RT RD X MEDICAL EQUIPMENT FORMULARY The Medical Equipment Formulary identifies an “X” next to the professional(s) who are authorized to order equipment on behalf of patients at Ontario Health atHome Equipment Ordering Guide by Professional Service Provider and Care Coordinators Professionals have different skill levels and experience […]

Home and Community Care Support Services Hamilton Niagara Haldimand Brant Palliative Symptom Response Order Form Guideline -2- 2 Purpose The purpose of the Palliative Symptom Response Order Form is the management of rapid-onset, unanticipated symptoms for patients nearing end of life and are no longer able to swallow oral medications . The medication on […]

Home and Community Care Support Services Hamilton Niagara Haldimand Brant Palliative Symptom Response Order Form Guideline -2- 2 Purpose The purpose of the Palliative Symptom Response Order Form is the management of rapid-onset, unanticipated symptoms for patients nearing end of life and are no longer able to swallow oral medications . The medication on […]

[…] 2 prior to infusion and every 30 minutes during infusion ☐ Monitor the patient for at least 30 minu tes and until clinically stable post infusionIron Infusion Order Form Fax completed form to 1-866-655-6402 Name: ______________________________________________________________________________________ Address: ____________________________________________________________________________________ Postal Code: _________________________________________________________________________________ Phone: _____________________________________________________________________________________ Date of Birth: ________________________________________________________________________________ OHC: _______________________________________________________________________________________ Alternate Phone Number: ______________________________________________________________________ ☐ […]

[…] 2 prior to infusion and every 30 minutes during infusion ☐ Monitor the patient for at least 30 minues and until clinically stable post infusion Iron Infusion Order Form Fax completed form to 1-866-655-6402 Name: ______________________________________________________________________________________ Address: ____________________________________________________________________________________ Postal Code: _________________________________________________________________________________ Phone: _____________________________________________________________________________________ Date of Birth: ________________________________________________________________________________ OHC: _______________________________________________________________________________________ Alternate Phone Number: ______________________________________________________________________ ☐ […]

Name : Health Card Number: DOB : Address: CONTINUOUS AMBULATORY DELIVERY DEVICE PATIENT CONTROLLED ANALGESIA (CADD SOLIS – PCA) PRESCRIPTION / ORDER DIAGNOSIS: ALLERGIES: No Yes Please list: In the event of anaphylaxis, community nursing service provider will follow their specific agency policy. PRESCRIPTION/ORDERS CADD Solis PCA Prescription/Orders Route: (Check one) Subcutaneous (S.C) Port-a-cath […]

Name : Health Card Number: DOB : Address: CONTINUOUS AMBULATORY DELIVERY DEVICE PATIENT CONTROLLED ANALGESIA (CADD SOLIS – PCA) PRESCRIPTION / ORDER DIAGNOSIS: ALLERGIES: No Yes Please list: In the event of anaphylaxis, community nursing service provider will follow their specific agency policy. PRESCRIPTION/ORDERS CADD Solis PCA Prescription/Orders Route: (Check one) Subcutaneous (S.C) Port-a-cath […]

[…] MEDICAL ASSISTANCE IN DYING (MAID ) PRESCRIPTION FORM HCCSS CENTRAL EAST 233 Alden Road Markham, ON L3R 3W6 T: 1-888-313-6988 F: 1-888-287-8577 Page 2 of 2  Order of Administration: Administration Medication Total Quantity Kit 1 Total Quantity Kit 2 Dosage Special Instructions/ Comments Authorized Practitioner Initials STEP 1: ANXIOLYSIS (Benzodiazepine) Midazolam 1mg/mL 10mg […]