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Protocol for Vascular Access Devices Medical Order Form – EN

To order care relating to vascular access devices in adults (in accordance with the Vascular Access Maintenance Protocol)

Medical Order Form – General

To order general medications, including wound care and maintenance for urinary catheters

Electrical Stimulation (eSTIM) Non-Formulary Order Form

Electrical Stimulation (eSTIM) non-formulary order form – fillable

Palliative SRK – Temiskaming District – Kirkland Lake Area Prescriber Order Form

Palliative Symptom Relief Kit (SRK) – Temiskaming District – Kirkland Lake Area Prescriber Order Form NOTE: This form must be faxed to Ontario Health atHome at 705-567-9407

Palliative SRK – Sudbury Prescriber Order Form

Palliative Symptom Relief Kit (SRK) – Sudbury Prescriber Order Form Please fax to Ontario Health atHome Care Coordinator @ 705-522-3855 The Ontario Health atHome Care Coordinator will send a copy of the form to: • Robinson’s Pharmacy Sudbury • Community Nursing Provider

Palliative SRK – Sault Ste. Marie Prescriber Order Form

Palliative Symptom Relief Kit (SRK) – Sault Ste. Marie Prescriber Order Form FAX to: Ontario Health at Home 705-949-1663

Palliative SRK – Parry Sound Prescriber Order Form

Palliative Symptom Relief Kit (SRK) – Parry Sound Prescriber Order Form ONLY a Ontario Health atHome Healthcare Provider may access kit for first dose. To be dispensed with Supply kit (SIV 0220). Please fax to 1-855-773-4056.The Care Coordinator will send a copy of the form to: Pharmasave Lane Family Pharmacy & Community Nursing Provider

Palliative SRK – North Bay Prescriber Order Form

Palliative Symptom Relief Kit (SRK) – North Bay Prescriber Order Form Please fax completed form to Robinson’s Pharmasave • North Bay Location (705) 495-4059 (Nipissing Region/Sturgeon Falls/Burk’s Falls/New Liskeard) • Sudbury Location (705) 560-6751 (Sudbury/Parry Sound/Port Loring)

Palliative SRK – Cochrane District – Kapuskasing Branch Order Form

Palliative Symptom Relief Kit (SRK) – Cochrane District – Kapuskasing Prescriber Order Form Procedure: 1. Place your initials and ✪dosing in the column of the table for any medications to be included in the SRK. 2. Fax to Ontario Health atHome at (705-267-7795) 3. Fax to patient’s participating pharmacy of choice: i. Wal-Mart (855-983-1050) […]

IV Therapy/Venous Access Management Medical Order Form

For help to complete the form, please call Ontario Health atHome’s central access team at 1-800-869-8828 ext. 4003. NOTE: Referral processing cannot be initiated unless page 1 of form is complete. Referring physician will be notified re missing & required information as soon as noted, in order to prevent delay in service arrangements.

Medical Order Form

Home and Community Care Support Services South East Medical Order Form

Transfer Order – Home and Community Care Support Services

News Posted:

[…] Care website March 17, 2021 – Additional Transfers to Ontario Health On March 17, 2021, the Honourable Christine Elliott, Deputy Premier and Minister of Health, issued an order under the Connecting Care Act, 2019 transferring the health system planning and funding functions of the Local Health Integration Networks (LHINs) to Ontario Health, effective April 1, 2021: […]