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NE-rapid-response-fr
06-2024 Personne-ressource Si vous a vez des ques ti ons a u s uj et de nos s ervi ces , n’hés i tez pa s à communi quer a vec: 310-2222 • ontariosanteadomicile.ca Personnel infirmier d’intervention rapide Le programme de personnel infirmier d’intervention rapide (PIIR) de Santé à domicile Ontario dans la région du […]
NW-information-and-referral-services-fr
06-2024 Services de renseignements et de renvoi Ête s-vous sorti de l’hôpital récemment après une chirurgie ou une grave maladie et avez -vous besoin d’aide pour vos activités quotidiennes? Votre enfant a -t-il be soin d’aide mé dicale à la maison ou à l’école? Vous occupez -vous d’une personne et avez – vous besoin d’une […]
NW-information-and-referral-services-fr
06-2024 Services de renseignements et de renvoi Ête s-vous sorti de l’hôpital récemment après une chirurgie ou une grave maladie et avez -vous besoin d’aide pour vos activités quotidiennes? Votre enfant a -t-il be soin d’aide mé dicale à la maison ou à l’école? Vous occupez -vous d’une personne et avez – vous besoin d’une […]
SE-Referral-Service-Request-Form-EN
[…] required record of service in the patient’s medical record is nil. The amount payable for home care supervision rendered on the same day as a consultation or visit by the same physician with the same patient is nil. K071 for Acute home care supervision (maximum 1 every week for the first 8 weeks following […]
Referral – Service Request Form – English
[…] required record of service in the patient’s medical record is nil. The amount payable for home care supervision rendered on the same day as a consultation or visit by the same physician with the same patient is nil. K071 for Acute home care supervision (maximum 1 every week for the first 8 weeks following […]
MH-Referral-form-EN
[…] Physician signature only r equired for nursing services. If Physician orders weightbearing, ROM or Functional Restrictions, please include all d etails below. Note: To ensure patient safety and care continuity, pleas e complete this Referral Form in full. Palliative referrals are to use the Palliati ve Care Services Referral Form available at healthcareathome.ca When […]
Referral Form – English
[…] Health atHome. Physician signature only required for nursing services. If Physician orders weightbearing, ROM or Functional Restrictions, please include all details below. Note: To ensure patient safety and care continuity, please comp lete this Referral Form in full. Palliative referrals are to use the Palliative Care Services Referral Form av ailable at healthcareathome.ca When […]
tc-palliative-care-referral-form-en
[…] TO ALL PALLIATIVE CARE PROVIDERS (For the purpose of this Form, an individual refers to a patient or client) Please complete this form as thoroughly as possible and PRINT clearly. Each referring agency, group or institution should decide which practitioner(s) is most appropriate to complete each section. Individual’s Last Name: First Name: Application Checklist […]
Palliative Care Referral Form – English
[…] TO ALL PALLIATIVE CARE PROVIDERS (For the purpose of this Form, an individual refers to a patient or client) Please complete this form as thoroughly as possible and PRINT clearly. Each referring agency, group or institution should decide which practitioner(s) is most appropriate to complete each section. Individual’s Last Name: First Name: Application Checklist […]
Adult Intravenous Remdesivir Infusion Therapy Order Form – English
[…] T IMM IN S 705 267 7795 Important information and instructions Ontario Health atHome uses a ‘Clinic First’ approach to service delivery. Eligibility for a home visit for IV intravenous infusion therapy will be determined by the Care Coordinator. Complete all sections of the form and fax it to the applicable office […]
tc-mhan-referral-form-viamonde-en
Mental Health and Addiction Nursing (MHAN) Program Conseil scolaire Viamonde REFERRAL FORM TEL: (416) 217 -3820 *FAX: (416) 506- 03 74 *PLEASE RETURN BY FAX ONLY A. Student Information – Completed by Parent/Guardian and School Student Name: Please print clearly Last N ame Date of Birth: YYYY MM DD ☐ Male ☐ Female First […]
tc-mhan-referral-form-viamonde-en
Mental Health and Addiction Nursing (MHAN) Program Conseil scolaire Viamonde REFERRAL FORM TEL: (416) 217 -3820 *FAX: (416) 506- 03 74 *PLEASE RETURN BY FAX ONLY A. Student Information – Completed by Parent/Guardian and School Student Name: Please print clearly Last N ame Date of Birth: YYYY MM DD ☐ Male ☐ Female First […]