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Version 21-003 Request for Home and Community Care Support Services Hamilton Niagara Haldimand Brant Patient Name ______________________________________ HCN _________________ VC ______ DOB __________________ Address _______________________________________ City _____________ Province ______ Postal Code _____________ Patient Phone ____________________ Contact Name _________________________ Contact Phone ___________________ ☐ Community: Fax completed form to 1-8 66-655-6 402 ☐ Hospital: Fax completed form […]

June 2018 v5 1.1.9 FORM NPWT Referral Information Sheet Negative Pressure Wound Therapy Referral Information Sheet 12 9 3 6 12 9 3 6 Before initiation of Negative Pressure Wound Therapy (NPWT), the ordering physician / Wound Care Clinician must complete the following information Date: Address: Client Name: BRN: Date of Birth (d/m/y): Wound History: […]

[…] be given to you by a device that holds the medication called an elastomeric device. There are many benefits of receiving IV medication through an elastomeric device such as: z Being able to disconnect from the device between doses z Light, discreet and portable to allow you to carry it around wherever you go […]

[…]  requiring  a palliative  approach  to  care   and  rely  on  primary  care  physicians  to  continue  managing  primary  care issues.   The  team  is  a  source  of  expert  advice   an d consultation  that  provide  specialist  palliative  care  services  for  patients   with  complex  needs  in  their  homes  or  places  of  residence.   The  services  available  are:   […]

[…] with the ministry, as appropriate. -3- Mr. Kenneth Joseph (“Joe”) Parker 6. Digital Delivery and Customer Service • Exploring and implementing digitization or digital modernization strategies for online service delivery and continuing to meet and exceed customer service standards through transition; and • Adopting digital approaches, such as user research, agile development and product […]

[…] Any diagnosis of being deve lopmenta lly delayed? □ Yes □ No Is the client medically stable? □ Yes □ No Specify: Does patient have a DNR order? □ Yes □ No Any Advance Directives? □ Yes □ No Specify: Specify: List any outstanding medical appointme nts of the client: Other Medical Needs: IV […]

Page 1 of 2 REFERRAL FORM FOR H OME & COMMUNITY CARE SER VICES – ADULT SPEECH LANGUAGE PATHOLOGY Please fax Referral Form(s) to Home and Community Care Support Services Toronto Central : 416-506-0374 Date: D M Y C LIENT INFORMATION Name: Telephone number: Alternate number: Ontario Health Card #: VC Address: Date of Birth: […]