South East area

South East Area Office Locations

  • Belleville
    470 Dundas St. East
    Belleville, ON, K8N 1G1
    Toll-free:  1-800-668-0901
    Fax:  613-966-0996
  • Bancroft
    1 Manor Lane
    Bancroft, ON, K0L 1C0
    Toll-free:  1-800-717-2344
    Fax:  613-966-0996
  • Brockville
    555 California Ave., Unit 1, Bag Service 7000
    Brockville, ON, K6V 7K6
    Toll-free:  1-800-267-6041
    Fax:  613-283-0308
  • Kingston
    200-1471 John Counter Blvd.
    Kingston, ON, K7M 8S8
    Toll-free:  1-800-869-8828
    Fax:  613-544-1494
  • Smiths Falls
    52 Abbott St. N., Suite 1
    Smiths Falls, ON, K7A 1W3
    Toll-Free:  1-800-267-6041
    Fax:  613-283-0308

Compliments and Concerns?

Please share your feedback with your care coordinator. You may also share compliments or concerns in the following ways:

Email: SEQuality@ontariohealthathome.ca

Phone: 613-650-2987

Mail: Ontario Health atHome
Attn: Senior Manager, Quality
470 Dundas St. East
Bay View Mall
Belleville, ON K8N 1G1

Newsroom and Media Relations

Visit our newsroom for more information on news and events. 

For all media-related enquiries, please contact media@ontariohealthathome.ca.

For non-media-related enquiries, please visit the Contact Us page to access additional contact information.

Forms

TitleSummaryRegionLast ModifiedCategoryFile TypeFile SizeLinkhf:doc_tagshf:doc_categorieshf:file_type
CADD SOLIS – PCA Prescription Order

Continuous Ambulatory Delivery Device Patient Controlled Analgesia Prescription Order.
Fax completed CADD Prescription/Order forms to Ontario Health atHome at 1-866-839-7299

October 11, 2024pdf6 MBsouth-eastformspdf
COVID-19 Remote Monitoring Program Referral Form

Patients enrolled in the COVID-19 Remote Monitoring Program use an app on their smartphone to report their symptoms to their nurse.

January 31, 2024pdf87 KBsouth-eastformspdf
First Dose Parenteral Medication Screener

First Dose Parenteral Medication Screener – South East

July 2, 2024pdf142 KBsouth-eastformspdf
Formulaire de demande pour la divulgation de renseignements personnels

Formulaire de demande pour la divulgation de renseignements personnels. En vertu de la Loi de 2004 sur la protection des renseignements personnels sur la santé Veuillez

, , , , , , , , , , , , , , September 19, 2024pdf229 KBcentral central-east central-west champlain erie-st-clair global hamilton-niagara-haldimand-brant mississauga-halton north-east north-simcoe-muskoka north-west south-east south-west toronto-central waterloo-wellingtonformspdf
Home Parenteral Nutrition Order Form

To order care relating to Home Parenteral Nutrition in the South East. NOTE: Two (2) business days notice required

April 19, 2024pdf159 KBsouth-eastformspdf
Infusion Therapy – IV Remdesivir Referral Form

Referral form for administering COVID-19 antivirals in South East community nursing clinics.

August 30, 2023pdf237 KBsouth-eastformspdf
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.

September 30, 2024pdf288 KBsouth-eastformspdf
Long-Term Care Home Choice Form (English)

You may choose up to five (5) long-term care homes.

June 8, 2023pdf1 MBsouth-eastformspdf
Long-Term Care Home Choice Form (French)

Formulaire de choix de foyer de soins de longue durée. Vous pouvez choisir jusqu’à cinq (5) foyers de soins de longue durée.

June 8, 2023pdf386 KBsouth-eastformspdf
MAiD Assessment Record

South East Medical Assistance in Dying Assessment Record, Please ensure form is completed and uploaded to patient’s CHRIS file.

July 2, 2024pdf110 KBsouth-eastformspdf
MAID Prescription/Order Form

By completing this form, the prescriber confirms that all safeguards have been met for the patient to be eligible to receive MAID.
Please ensure form is completed for accuracy. Once completed fax to 1-888-334-6559.

September 24, 2024pdf110 KBsouth-eastformspdf
MAID Procedural Record

South East Medical Assistance in Dying Procedural Record

July 2, 2024pdf101 KBsouth-eastformspdf
Medical Order Form

Home and Community Care Support Services South East Medical Order Form

July 2, 2024pdf253 KBsouth-eastformspdf
MHAN Referral Form

Mental Health & Addiction (MHAN) Nurse Referral. Please fax to: 1-613-650-2992

May 7, 2024pdf242 KBsouth-eastformspdf
Negative Pressure Wound Therapy – Supplies & Equipment Order Form

Fax: 613-650-2996
*Hospital: Use hospital Ontario Health atHome fax number

July 22, 2024pdf99 KBsouth-eastformspdf
Negative Pressure Wound Therapy Referral Form

Note: NPWT will continue to be assessed in the community, and settings may be reviewed based on exudate and patient tolerance. Continuation of NPWT is dependent on wound healing goals being met. Maximum treatment time for NPWT is 8 weeks.

July 19, 2024pdf102 KBsouth-eastformspdf
Palliative Care SBAR Communication Tool for Nurses

Palliative Care SBAR Communication Tool for Nurses in the South East

July 2, 2024pdf54 KBsouth-eastformspdf
Referral and Order Requisition for Offloading Devices

Complete this form to refer patients to approved regional providers for offloading footwear

July 2, 2024pdf215 KBsouth-eastformspdf
Referrals from Hospital

Ontario Health atHome – South East referrals from hospital

July 2, 2024pdf108 KBsouth-eastformspdf
Request for Release of Personal Health Information

Request for Release of Personal Health Information under the Personal Health Information Protection Act, 2004

, , , , , , , , , , , , , , September 19, 2024pdf2 MBcentral central-east central-west champlain erie-st-clair global hamilton-niagara-haldimand-brant mississauga-halton north-east north-simcoe-muskoka north-west south-east south-west toronto-central waterloo-wellingtonformspdf
Service Requests/Referrals

Ontario Health atHome, South East area service request/referral form

June 29, 2024pdf269 KBsouth-eastformspdf
SRK for End-of-Life Order Form (French)

Trousse de gestion des symptômes pour les soins en fin de vie – Formulaire de commande

May 9, 2024pdf2 MBsouth-eastformspdf
Symptom Response Kit (SRK) for End-of-Life Order Form

Timing and placement of the Symptom Response Kit requires careful consideration with a goal of avoiding emergency room visit or hospital admission.

July 2, 2024pdf151 KBsouth-eastformspdf