Version 21.001 Medical Order for the Administration of Influenza Vaccine Contact Home and Community Care Support Services HNHB at 1-800 -810- 0000 Patient Name _____________________ ______________ HCN __________ _______ VC _______ DOB _____ _____ ______ Address ________ ________________________________ City _____________ Province __ __ Postal Code ____ _______ Patient Phone # ________________ _ Contact Name […]
Version 21.001 Medical Order for the Administration of Influenza Vaccine Contact Home and Community Care Support Services HNHB at 1-800 -810- 0000 Patient Name _____________________ ______________ HCN __________ _______ VC _______ DOB _____ _____ ______ Address ________ ________________________________ City _____________ Province __ __ Postal Code ____ _______ Patient Phone # ________________ _ Contact Name […]
Version 21.001 Medical Order for the Administration of Influenza Vaccine Contact Home and Community Care Support Services HNHB at 1-800 -810- 0000 Patient Name _____________________ ______________ HCN __________ _______ VC _______ DOB _____ _____ ______ Address ________ ________________________________ City _____________ Province __ __ Postal Code ____ _______ Patient Phone # ________________ _ Contact Name […]
PALLIATIVE SYMPTOM RELIEF KIT PRESCRIBER ORDER FORM SUDBURY Version 4 ( 08/0 4/2025 ) Page 1 of 1 Name : HCN: DOB ( DD/MM/YYYY) : Allergies: Address : Te l e phone #: ( 705) Standard Kit contains: *NURSE TO ACCESS KIT ONLY* LORAZEPAM 1 MG Dispense: 8 tabs Directions: For anxie ty or […]
Ver sion 4 (28/06/2024) Page 1 of 1 PAL LIATIVE SYMPTOM RELIE F KIT PRESCRIBER ORDER FORM – Parry Sound Name: HCN: DOB (DD/MM/YYYY): Phone #: Address: Allergies: ONLY a Ontario Health atHome Healthcare Provider may access kit for first dose. To be dispensed with Supply kit (SIV 0220). Prescri ber to check items […]
□ N M k b a e o o e M Tel: 705 721 -8010 Fax: 705 792- 6270 SYMPTOM RELIEF KIT (SRK) FOR PALLIATIVE CARE ‐ ORDER FORM PATIENT INFORMATION Last Name First Name Date of Birth (YYYY/MM/DD) Address Gender Male Female Health Card Number City Postal Code Phone Number Allergies EDITH Protocol […]
FA X t o : Ontario Health at Ho me 705-949-1663 Uncl a ssified SYM P TOM RELIEF KIT P RESCRIPTION -Sault Ste Marie Patie nt Name : __________________________________Pho ne: _ _ __ __ __ __ __ __ __ __ ___ Addre s s : _______________ __ __ __ __ __ __ __ __ __ […]
Formulaire de demande d’une trousse de ges�on des symptômes pour les soins en fin de vie | 2 Non classifi é Formulaire de demande d’une trousse de gestion des symptômes pour les soins en fin de vie Veuillez transmetre par télécopieur le formulaire dûment rempli au bureau approprié de Santé à domicile Ontario. Centre -Est […]
[…] professionals help people heal at home and live in their homes longer. We will also connect you with support services and resources available in your community, in order to assist with your care which could include but is not limited to meal delivery and transportation services. Anyone can refer a patient to Ontario Health […]
[…] the decision and appreciates the reasonably foreseeable consequences of the decision); 16 years of age or older; Available to make the decision; and Not prohibited by court order or separation agreement from having access to the incapable person, or giving or refusing consent on his or her behalf. An individual can identify a substitute […]
[…] It has been built to interoperate with longer term eHealth initiatives and to enable partner access to health information held within Ontario Health atHome tools and applications such as the Client Health and Related Information System (CHRIS). HPG makes it simple to share information between Ontario Health atHome and health partners, in a safe and […]
[…] how the Total Contact Cast (TCC) has impacted her life. What is a Diabetic Foot Ulcer? If you have diabetes type 1 or 2, you are at an increased risk of developing a diabetic foot ulcer – an open sore or wound commonly located on the bottom of the foot. Due to pressure to […]
