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Information on planning and applying for long-term care
Relocating from one home to another can be challenging – and this includes deciding whether to move into a long-term care home.
We are here to help you and your family understand and make the right decision about your readiness and eligibility for long-term care.

Effective Date: December 3, 2025
Note: Manufacturer Back Order and Discontinuation lists are reviewed and validated on a weekly basis and will be updated
if there are changes to the list

Ontario Health atHome is responsible for placement coordination to long-term care homes. This is a guide to Placement in Long-Term Care Homes

We’re here to help. Ontario Health atHome coordinates in-home and community-based care for over 400,000 patients every month.
Our mission is to help everyone be healthier at home through connected, accessible, patient-centred care.
We assess patient care needs and deliver in-home and
community-based services to support your health and wellbeing. We also provide access and referrals to other community services and manage Ontario’s longterm care home placement process.

Effective September 30, 2025
This document provides a formulary listing of Infusion and Enteral therapy supplies by geography available to order categorized by Vendor Contract Type, Master Item Code, Description, and Item Unit Type.
For information on extended manufacturer medical equipment and supply outages, please refer to the MES Manufacturer Backorder Report.

Effective March 18, 2025
This document provides a formulary listing of medical equipment categorized by vendor, item code, item description, product category and manufacturer name.

For information on extended manufacturer medical equipment and supply outages, please refer to the MES Manufacturer Backorder Report.

Effective September 30, 2025
This document provides a formulary listing of Fulfilment supplies available to order categorized by Vendor Contract Type, Master Item Code, Description, and Product Type.
For information on extended manufacturer medical equipment and supply outages, please refer to the MES Manufacturer Backorder Report.

Effective September 30, 2025
This document provides a simplified formulary listing categorized by Vendor Contract Type, Master Item Code, Description, and Item Unit Type.
For information on extended manufacturer medical equipment and supply outages, please refer to the MES Manufacturer Backorder Report.

Service Provider Organizations must provide services in French. The availability of bilingual staff may vary depending on the patient needs and health care.

Les organismes fournisseurs de services doivent offrir des services en français. La disponibilité d’employés bilingues peut varier en fonction des besoins du p

Last update: November 2025

Please fax to: 613.745.8243 or 1.855.450.8569
Information contained in this form is private and confidential, intended only for the named recipient(s).
If you received this in error, please notify the sender by phone immediately and secure the information until the sender provides you with more direction. Do not copy or disclose this information to anyone else.

For Adults 18 years +
First dose requests may take longer to process and the decision to administer the first dose parenteral medication is made by the Service Provider.

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The child and family services program is a specialized program which provides care coordination, professional and personal support services to children, youth and their families to assist with short or long-term health needs. Depending on their needs, children or youth may receive services in their homes, at school, or in both settings.

Medical Referral Paediatric for patients under 18 years of age.
Patients may have care in a nursing clinic and be taught their treatments based on nurses discretion.

For Adults 18 years +
First dose requests may take longer to process and the decision to administer the first dose parenteral medication is made by the Service Provider.

North Simcoe Muskoka Medical Referral Form Adult

Nursing services are primarily provided in clinics, with in-home care only by exception. Prescribers must ensure therapy is appropriate and safe; first dose requests may take longer and are at the nursing provider’s discretion. Patients receive self-management teaching and follow-up, and services are not duplicated. Ineligible medications include blood products, naturopathic, and experimental treatments.

Nursing services are primarily provided in clinics, with in-home care only by exception. Prescribers must ensure therapy is appropriate and safe; first dose requests may take longer and are at the nursing provider’s discretion. Patients receive self-management teaching and follow-up, and services are not duplicated. Ineligible medications include blood products, naturopathic, and experimental treatments.

Nursing services are primarily provided in clinics, with in-home care only by exception. Prescribers must ensure therapy is appropriate and safe; first dose requests may take longer and are at the nursing provider’s discretion. Patients receive self-management teaching and follow-up, and services are not duplicated. Ineligible medications include blood products, naturopathic, and experimental treatments.

For Adults 18 years +
First dose requests may take longer to process and the decision to administer the first dose parenteral medication is made by the Service Provider.

Nursing services are primarily provided in clinics, with in-home care only by exception. Prescribers must ensure therapy is appropriate and safe; first dose requests may take longer and are at the nursing provider’s discretion. Patients receive self-management teaching and follow-up, and services are not duplicated. Ineligible medications include blood products, naturopathic, and experimental treatments.

Nursing services are primarily provided in clinics, with in-home care only by exception. Prescribers must ensure therapy is appropriate and safe; first dose requests may take longer and are at the nursing provider’s discretion. Patients receive self-management teaching and follow-up, and services are not duplicated. Ineligible medications include blood products, naturopathic, and experimental treatments.

Reference Document: Community Adult Flushing and Vascular Access Maintenance Protocol for Central Venous Access Devices (CVAD) and Peripheral Intravenous Catheters (PIVC)

For Adults 18 years +
First dose requests may take longer to process and the decision to administer the first dose parenteral medication is made by the Service Provider.

For Adults 18 years +
First dose requests may take longer to process and the decision to administer the first dose parenteral medication is made by the Service Provider.

For Adults 18 years +
First dose requests may take longer to process and the decision to administer the first dose parenteral medication is made by the Service Provider.

For Adults 18 years +
First dose requests may take longer to process and the decision to administer the first dose parenteral medication is made by the Service Provider.

For Adults 18 years +
First dose requests may take longer to process and the decision to administer the first dose parenteral medication is made by the Service Provider.

For Adults 18 years +
First dose requests may take longer to process and the decision to administer the first dose parenteral medication is made by the Service Provider.

For Adults 18 years +
First dose requests may take longer to process and the decision to administer the first dose parenteral medication is made by the Service Provider.

For Adults 18 years +
First dose requests may take longer to process and the decision to administer the first dose parenteral medication is made by the Service Provider.

For Adults 18 years +
First dose requests may take longer to process and the decision to administer the first dose parenteral medication is made by the Service Provider.

For Adults 18 years +
First dose requests may take longer to process and the decision to administer the first dose parenteral medication is made by the Service Provider.

For Adults 18 years +
First dose requests may take longer to process and the decision to administer the first dose parenteral medication is made by the Service Provider.

Nursing services are primarily provided in clinics, with in-home care only by exception. Prescribers must ensure therapy is appropriate and safe; first dose requests may take longer and are at the nursing provider’s discretion. Patients receive self-management teaching and follow-up, and services are not duplicated. Ineligible medications include blood products, naturopathic, and experimental treatments.

Nursing services are primarily provided in clinics, with in-home care only by exception. Prescribers must ensure therapy is appropriate and safe; first dose requests may take longer and are at the nursing provider’s discretion. Patients receive self-management teaching and follow-up, and services are not duplicated. Ineligible medications include blood products, naturopathic, and experimental treatments.

Nursing services are primarily provided in clinics, with in-home care only by exception. Prescribers must ensure therapy is appropriate and safe; first dose requests may take longer and are at the nursing provider’s discretion. Patients receive self-management teaching and follow-up, and services are not duplicated. Ineligible medications include blood products, naturopathic, and experimental treatments.

Nursing services are primarily provided in clinics, with in-home care only by exception. Prescribers must ensure therapy is appropriate and safe; first dose requests may take longer and are at the nursing provider’s discretion. Patients receive self-management teaching and follow-up, and services are not duplicated. Ineligible medications include blood products, naturopathic, and experimental treatments.

Nursing services are primarily provided in clinics, with in-home care only by exception. Prescribers must ensure therapy is appropriate and safe; first dose requests may take longer and are at the nursing provider’s discretion. Patients receive self-management teaching and follow-up, and services are not duplicated. Ineligible medications include blood products, naturopathic, and experimental treatments.

Nursing services are primarily provided in clinics, with in-home care only by exception. Prescribers must ensure therapy is appropriate and safe; first dose requests may take longer and are at the nursing provider’s discretion. Patients receive self-management teaching and follow-up, and services are not duplicated. Ineligible medications include blood products, naturopathic, and experimental treatments.

Nursing services are primarily provided in clinics, with in-home care only by exception. Prescribers must ensure therapy is appropriate and safe; first dose requests may take longer and are at the nursing provider’s discretion. Patients receive self-management teaching and follow-up, and services are not duplicated. Ineligible medications include blood products, naturopathic, and experimental treatments.

Nursing services are primarily provided in clinics, with in-home care only by exception. Prescribers must ensure therapy is appropriate and safe; first dose requests may take longer and are at the nursing provider’s discretion. Patients receive self-management teaching and follow-up, and services are not duplicated. Ineligible medications include blood products, naturopathic, and experimental treatments.

Nursing services are primarily provided in clinics, with in-home care only by exception. Prescribers must ensure therapy is appropriate and safe; first dose requests may take longer and are at the nursing provider’s discretion. Patients receive self-management teaching and follow-up, and services are not duplicated. Ineligible medications include blood products, naturopathic, and experimental treatments.

If you are suffering from an acute or chronic illness, coping with disability, or experiencing the effects of aging and loneliness, you may also be struggling mentally and emotionally. Families and caregivers can be equally affected. Our social workers are regulated health professionals who offer much more than simply someone to talk to – they play a key role in a patient’s circle of care.

Being able to communicate your needs, or just to reach out to another person, is something we all value. If your ability to speak or swallow has been affected by a stroke or other illness, a Speech Language Pathologist may be able to help bring you back into the conversation.

If you or a loved one are finding it more and more difficult to stay active or move freely after a recent illness or injury, a Physiotherapist may be able to help. Physiotherapy can improve your ability to physically function, increase your safety, reduce pain, and enhance your general health and well-being.

Chatham Branch: Tel: 519 351-5677
Fax: 519-351-5842

Sarnia Branch: Tel: 519-337-1000
Fax: 519-337-4331

Windsor Branch: Tel: 519-258-8211
Fax: 519-258-6288

Ontario Health atHome coordinates the accommodation of people in North Simcoe and Muskoka’s Long-Term Care Homes (LTCH). These homes are located across the region and provide a diverse range of specialized and personalized services. All LTCHs are licensed and regulated by the Ministry of Long-Term Care (Ministry). The Ministry conducts inspections to ensure compliance with legislation and regulations. They also regulate the fees for longterm care and the standards of service. Reports on LTCHs are available at publicreporting.ltchomes.net (opens in a new tab) . For more information on LTCHs and other health service resources call 310-2222 or visit Health Line (opens in a new tab) .

Helping students thrive, cope and succeed:
Living with mental health issues and/or an addiction is difficult for anybody of any age. When you add in the social and academic pressures of being a student, life can sometimes feel unbearable. Mental Health and Addictions Nurses provide early intervention, psycho-educational support and therapeutic strategies that addresses specific mental health and addiction needs for children and youth.

Ontario Health atHome connects, supports, and cares for patients who have a life-limiting illness. Our skilled team helps patients and families understand their options and provides support for their choices.

Access to Remdesivir in the Community
Remdesivir is available to patients in the community through Ontario Health atHome. Prescribers in hospitals or in the community can refer a patient to their local Ontario Health atHome office for a nurse to administer Remdesivir infusions. Prescribers must complete the appropriate referral form(s) and submit to their local Ontario Health atHome office. An Ontario Health atHome care coordinator will follow up with the patient.

Fax form to CBA team at 519-742-0635

Highland Retirement Home
20 Fieldgate St, Kitchener, ON

Stone Lodge Retirement Residence
165 Cole Rd, Guelph, ON

FAX COMPLETED FORM TO Ontario Health atHome: 519-742-0635
How is Crisis defined?
A patient is considered to be “In Crisis” if:
1. Patient and/or caregiver safety is at risk and/or there is a risk that a significant health event and/or challenging end-of-life symptoms cannot be managed in their current setting
2. Patient at risk of requiring ED or acute care admission
3. Community resources have been exhausted and family/ caregivers are unable to cope with the patient’s care needs
4. There is a risk that the services required to meet the patient’s end-of-life care plan goals may not be available in their current setting
5. Patient at risk of not accessing their preferred place of death (considering recent trajectory of the PPS score).

If you or a loved one require convalescent, respite or interim care and are considering short-stay placement in a Long-Term Care Home, this guide will answer many of your questions and help you make the right decision for you and your family.
Your Care Coordinator is here to support you through the assessment, application and admission process.

Safety is important and everyone plays a role. If you are receiving care in the home, you can expect that your Care Coordinator or service provider will complete a safety assessment during their first visit with you and provide recommendations on how to be safe in your home.

If you have received information directly from the long-term care home where you are staying, please use in conjunction with this information.

Ontario Health atHome Posting of Travel, Meal and Hospitality.
Executive Expense Report for Designated Individuals for Quarter 2 – Fiscal Year 2025-26

Ontario Health atHome Posting of Travel, Meal and Hospitality Board of Directors Expense for Quarter 2 – Fiscal Year 2025/26

Medigas Medical Equipment Catalogue for the following areas: North East and North West
October 2025

Medigas Medical Equipment Catalogue for the following areas: Central, Central West, Mississauga Halton, North Simcoe Muskoka & Toronto Central
October 2025

Pediatric Patients at McMaster Children’s Hospital (MCH) Hamilton
Toll Free Phone Number: 1-800-810-0000

To order care relating to the Protocol for Home Parenteral Nutrition (PPN or TPN) for pediatric patients at McMaster Children’s Hospital. Contact HNHB at 1-800-810-0000

வீடு மற்றும் சமூகப் பராமாிப்பு ஆதார உதவிச் சசவவகள் ச?ாயாளர் உாிவமகளுககான சட்டவவரவு

ਇੱੱਕ ਮਰੀੀਜ਼, ਪਰਿਰੀਵਾਾਰੀਕ ਮਂਬਰੀ, ਬਦਲਵਾਂ ਫੈੈਸਲੇ ਲੈ ਣ ਵਾਾਲੇ ਜਾਂਾ� ਦੇਖਭਾਾਲ ਕਰੀਨ ਵਾਾਲੇ ਦੇ ਤੌੌਰੀ ‘ਤੌੇ, ਤੌੁਹਾਾਨ� ੰ ਇੱਹਾ ਉਮੀਦ ਕਰੀਨ ਦਾ ਅਰਿ�ਕਾਰੀ ਹਾੈ ਰਿਕ ਹਾਰੀ ਓਨਟਾਾਰੀੀਓ ਹਾੈਲਥ ਐਟਾ ਹਾੋਮ ਕਰੀਮਚਾਾਰੀੀ, ਬੋਰੀਡ ਮਂਬਰੀ ਅਤੌੇ ਇੱਕਰੀਾਰੀਨਾਮੇ ਵਾਾਲੇ ਰਿਸਹਾਤੌ ਸੇਵਾਾਵਾਾ� ਦੇਣ ਵਾਾਲਾ ਤੌੁਹਾਾਡੇ ਅਰਿ�ਕਾਰੀਾ� ਦਾ ਸਰਿਤੌਕਾਰੀ ਅਤੌੇ ਪਰਚਾਾਰੀ ਕਰੀੇਗਾਾ ਰਿਜਾਂਵਾਂ ਰਿਕ

Jako pacjent, członek rodziny lub opiekun, masz prawo oczekiwać, że każdy pracownik Ontaryjskiej Służby Zdrowia w Domu ( Ontario Health at Home), członek zarządu lub kontraktor świadczący usługi medyczne będzie szanować i promować Twoje prawa. Jako konsument masz prawo

In qualità di paziente, familiare, tutore od operatore sanitario, Lei ha il diritto di aspettarsi che tutti i dipendenti del dipartimento Sanità a domicilio Ontario, i consiglieri e gli operatori sanitario a contratto rispettino e promuovano i Suoi diritti, di seguito enunciati.

身為病患、家屬、替代決策者或照護人員，您有權期望每位安大略居家保健員工、董事會成員和簽約醫療服務提供者尊重並促進您的以下權利

Fax completed form to 1-866-655-6402
Note –If patient is receiving treatment through Ontario Health atHome the medication will be provided to the patient through Calea. Do not have patient pick the medication up from their own pharmacy.

Form ONC 537 E MR22 for Service Providers
Nursing Agency to fax the completed and/or reviewed HPP to the appropriate Primary Health Care Provider(s) and Funeral Director (if consent obtained).
Nursing Agency to send completed and/or revised HPP to Ontario Health atHome via Health Partner Gateway (HPG).
When HPG is unavailable, fax to:
Chatham: 519-351-5842
Windsor: 519-258-6288
Sarnia: 519-337-4331

Effective September 30, 2025
Fax: 1-855-697-7358

*Hospital: Use hospital Ontario Health atHome fax number

Effective September, 2025
Fax: 1-855-697-7358

*Hospital: Use hospital Ontario Health atHome fax number

Effective September 30, 2025
Fax: 1-855-697-7358
*Hospital: Use hospital Ontario Health atHome fax number

This document provides a list of infusion and supply kit contents categorized by kit name and component items within each kit. Effective September 30, 2025

Quyền của Bệnh nhân
Là bệnh nhân, thành viên gia đình, người ra quyết định thay thế hoặc người chăm sóc, bạn có quyền mong đợi mọi nhân viên, thành viên Hội đồng Quản trị và nhà cung cấp dịch vụ y tế theo hợp đồng của Sức khỏe tại nhà Ontario sẽ tôn trọng và thúc đẩy các quyền của bạn như sau:

रोगी अधिकार विधेयक

एक रोगी, परिवार के सदस्य, वैकल्पिक निर्णयकर्ता या देखभालकर्ता के रूप में, आपको यह अपेक्षा करने का अधिकार है कि ओंटारियो हेल्थ एटहोम का प्रत्येक कर्मचारी, बोर्ड सदस्य और अनुबंधित स्वास्थ्य सेवा प्रदाता आपके निम्नलिखित अधिकारों का सम्मान और संवर्धन करेगा:

ميثاق حقوق المريض
بصفتك ريضًًا، أو فر اًً ن أفراد أسرتك، أو مُُتخذ قرار بديل، أو مُُقدم رعاية، يحق لك توقع احترام وتعزيز محقوقك ن بِِل كل وظف، وع و جلس إدارة، ومُُقدم خد ات صحية مُُتعاقد عه في خد ات الرعاية
الصحية في المنزل في اونتاريو، على النحو التالي:

患者权利法案
作为患者、家庭成员、替代决策者或护理人员，您有权期望每一位安大略居家保健员工、董事会成员和签约医疗服务提供者尊重并促进您的以下权利：

Διακήρυξη Δικαιωμάτων Ασθενών
Ως ασθενής, συγγενής, αναπληρωτής υπεύθυνος λήψης αποφάσεων ή πάροχος φροντίδας, έχετε το δικαίωμα να περιμένετε από κάθε υπάλληλο, μέλος του διοικητικού συμβουλίου και συμβεβλημένο πάροχο υγειονομικής περίθαλψης του Περίθαλψη κατ’ οίκον Οντάριο να σέβεται και να προωθεί τα δικαιώματά σας ως εξής:

Declaração de Direitos do Paciente
Como paciente, familiar, tomador de decisões substituto ou cuidador, você tem o direito de esperar que todos os funcionários, membros do Conselho e prestadores de serviços de saúde contratados do Ontario Health atHome (Saúde em Casa Ontário) respeitem e promovam seus direitos da seguinte forma:

Декларация о правах пациента
Содрудники Онтарио Health atHome , члены правления и поставщики медицинских услуг обязуются уважать и защищать права пациентов, членов семьи, лиц, принимающих решения, или опекунов следующим образом:

As a patient, family member, substitute decision maker or caregiver, you have the right to expect that every Ontario Health atHome employee, Board member and contracted health service provider shall respect and promote your rights as follows:

Declaración de derechos del pacientes
Como paciente, familiar, sustituto en la toma de decisiones o cuidador, tiene derecho a que todos los empleados de La salud en casa Ontario, los miembros de la Junta y los proveedores de servicios sanitarios contratados respeten y promuevan sus derechos de la siguiente manera::

Bill of Rights ng Pasyente
Bilang isang pasyente, miyembro ng pamilya, kapalit na gumagawa ng desisyon o tagapag-alaga, may karapatan kang asahan na ang bawat empleyado ng Kalusugan saBahay ng Ontario, miyembro ng Lupon at nakakontratang tagapagbigay ng serbisyong pangkalusugan ay dapat igalang at itaguyod ang iyong mga karapatan tulad ng sumusunod:

As a patient, family member, substitute decision maker or caregiver, you have the right to expect that every Ontario Health atHome employee, Board member and contracted health service provider shall respect and promote your rights as follows:

We strive to provide outstanding care to all Ontario Health atHome patients. Hearing from you helps us strengthen services and patient experiences.

Please Fax Hospice applications and eShift PCCRs as these are considered Urgent.

Ontario Health atHome operates over 135 community nursing clinics to provide free, high-quality, specialized nursing care. All of our clinics are by appointment only, in accessible locations, and many have extended operating hours.

Ontario Health atHome operates over 135 community nursing clinics to provide free, high-quality, specialized nursing care.
All of our clinics are by appointment only, in accessible locations, and many have extended operating hours.

Ontario Health atHome operates over 135 community nursing clinics to provide free, high-quality, specialized nursing care. All of our clinics are by appointment only, in accessible locations, and many have extended operating hours.
Community nursing clinics provide publicly-funded, patient-centred, high-quality, specialized nursing care.
Clinic nurses will jointly design a care plan and schedule based on your needs and health goals. They provide specialized services – including wound care, intravenous therapy, catheter, diabetes, ostomy care – and health teaching to meet your needs.

Find a nursing clinic near in the South West region as at September 2025.

Letter of mandate outlining government’s 2024-25 priorities for Home and Community Care Support Services organizations.

This booklet will help you:

• Manage your wound at home,
• Improve and maintain your health and quality of life,
• Prevent new wounds.

You can use this booklet and the accompanying passport to:

• Keep track of information about your care,
• Guide your day-to-day wound care,
• Know when you need to call your care team,
• Ensure that your wound is being managed in the best way possible.

Ontario Health atHome operates over 135 community nursing clinics to provide free, high-quality, specialized nursing care. All of our clinics are by appointment only, in accessible locations, and many have extended operating hours.

Phone: 800-263-3877
Fax: 855-352-2555

This form is to be used for completion of the assessment required under the Fixing Long-Term Care Act, 2021 when a person applies for a determination of eligibility for long-term care home admission. The required assessment is of the applicant’s physical and mental health, and the applicant’s requirements for medical treatment and health care. This assessment must be made by a physician or registered nurse.

You may choose up to five (5) long-term care homes (LTCH). Please list LTCHs in order of preference. You must be prepared to accept whichever one becomes available first, however, you can then wait in that LTCH for your first choice to become available.

This provincial policy supersedes any and all local policies directing activity covered in this policy. All local policies that are replaced must be archived and maintained per local processes. Where local differences in procedure tied to this policy cannot yet be fully standardized to a
provincial approach, these differences will be captured in the local procedure.

Statement of financial position for Ontario Health atHome as at March 31, 2025
Management of Ontario Health atHome is responsible for the integrity, consistency, objectivity and reliability of the financial statements. These financial statements have been prepared by management in accordance with Canadian public sector accounting standards including the 4200 series for government not-for-profit organizations and, where appropriate, include amounts based on management’s best estimates and judgements. Estimates and assumptions are based on historical experience, current conditions and various other assumptions believed to be reasonable in the circumstances.

Coordinated Bed Access referrals are coordinated by Ontario Health atHome WW. The Hospital will be sharing your medical and personal information with Ontario Health atHome WW. Ontario Health atHome WW will add your name to the waiting list. Your initials and gender will be accessible to Ontario Health atHome WW’s other hospital partners. The hospital and Ontario Health atHome WW will share your medical and personal information with the Rehabilitation program.

Office Location: 180 Riverview Dr, Chatham
Fax: 1-519-258-6288

Completed by a Coordinated Bed Access Coordinator (Ontario Health atHome staff) for transfers in the rehab bed program.
Please fax completed form and updated letter of understanding to Ontario Health atHome (519) 742-0635
For Neurobehavioural and Geriatric Assessment Units fax to (519) 749-4326

Info for Service Providers

Info for Services Providers

Fax: 1-855-697-7358

*Hospital: Use hospital Ontario Health atHome fax number

Last Update: June 2025
Fax: 1-855-697-7358

*Hospital: Use hospital Ontario Health atHome fax number

Fax: 1-855-697-7358

*Hospital: Use hospital Ontario Health atHome fax number

Medical Equipment and Supply Fax Number: 1-855-697-7358

*Hospital: Use hospital Ontario Health atHome fax number

Ontario Health atHome operates over 135 community nursing clinics to provide free, high-quality, specialized nursing care.
All of our clinics are by appointment only, in accessible locations, and many have extended operating hours.

Ontario Health atHome operates over 135 community nursing clinics to provide free, high-quality, specialized nursing care. All of our clinics are by appointment only, in accessible locations, and many have extended operating hours.

Elevating extraordinary people, Advancing exceptional care

At Ontario Health atHome, our people are our greatest asset. Rooted in
our mission, vision and values, our People Strategy is refreshed annually to reflect evolving priorities.

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

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 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 Symptom Relief Kit (SRK) – Manitoulin Island Prescriber Order Form
1. Prescribers: Fax to patients pharmacy of choice:
I. Guardian Pharmacy – Gore Bay (705-282-0792), Little Current (705-368-2077),
Manitowaning (705-859-2280), or Mindemoya (705-377-5310)
II. Edgewater Pharmacy – Little Current (705-368-3131)
AND
2. Pharmacists: Fax to Ontario Health atHome (705-522-3855) to ensure CC can order supplies to
patients pharmacy of choice

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)
ii. Shopper’s Drug Mart (705-337-1661)
iii. Rexall (705-337-1877)
4. Family to pick-up SRK & Supplies at dispensing pharmacy.
5. SRK is for short term use only. Prescriptions must be sent for ongoing use for specific medications needed.

Memorandum of Understanding Among Minister of Health, Chair of Ontario Health, and Chair of Ontario Health at Home
The purpose of this tripartite Memorandum of Understanding (MOU) is to:

• Establish the accountability relationships among the Minister of Health, the Chair of Ontario Health and the Chair of Ontario Health atHome;
• Clarify the roles and responsibilities of the Minister, the Agency Chair, the Subsidiary Chair, the Deputy Minister, the Agency CEO, the Agency’s Board, the Subsidiary CEO, and the Subsidiary’s Board.
• Clarify the operational, administrative, financial, staffing, auditing, and reporting arrangements among Ontario Health atHome, Ontario Health and the Ministry of Health.

* Note: Medical conditions must be stable, managed in an RN/RPN scope, not require daily MD assessment.

Timing and placement of the Symptom Response Kit (SRK) requires careful consideration (i.e. prognosis is less than six months; patient expected to deteriorate quickly) with goal of avoiding emergency room visit or hospital admission.
Medications in the SRK will expire; therefore, will need to be reviewed and reordered by the physician/Nurse Practitioner (NP) if it remains appropriate. Consider reviewing goals of care and expected home death protocols

Long-Term Care Home Crisis Choice List | Choix des foyers de soins de longue durée en cas de Crise

Care coordinators assist you and your family in the long-term care home admission process. When you apply for admission, you are encouraged to choose five homes. You will be offered the first one available.

Ontario Health atHome Posting of Travel, Meal and Hospitality Board of Directors Expense for Quarter 1 – Fiscal Year 2025/26

Ontario Health atHome Posting of Travel, Meal and Hospitality.
Executive Expense Report for Designated Individuals for Quarter 1 – Fiscal Year 2025-26

*Patients requiring palliative care can be admitted from any sending facility in the system, including Home (admissions from LTC will be considered on a case-by-case basis after a palliative pain an symptom managing consult is completed).

Inpatient rehabilitative care is the next step in your recovery. It will help you work towards regaining your strength and independence. It will also help you with returning to your usual activities as much as possible.

* Note – medical conditions must be stable, managed in an RN/RPN scope, not require daily MD assessment.

* Note – medical conditions must be stable, managed in an RN/RPN scope, not require daily MD assessment

Please select up to five long-term care homes for short stay respite, including any out-of-Champlain choices, and rank them in order of your preference. The applicant’s name will be added to the wait lists for the chosen homes if eligible, and if the chosen long-term care homes can provide the required care. Ontario Health atHome will confirm with you the availability of the requested dates.

This document is for patients who are considering placement in long-term care homes and their caregivers. This information is provided to help you with decision-making and provides basic information about what different long-term care homes have to offer their residents.
We strongly encourage patients and caregivers to research and visit each home the patient is considering living in. It is important to gather all the information that would help your family make sound decisions on which homes would be suitable for your loved one.

Please select up to five long-term care homes for short stay interim and rank them in order of your preference.
The applicant’s name will be added to the wait listsfor the chosen homesif eligible, and if the chosen long-term care homes can provide the required care.
Ontario Health atHome will notify you about the eligibility. Short Stay Interim beds are available to all hospital Alternative Levels of Care to long-term care patient.

當您在家獨立生活變得困難時，長期護理院是讓您安全、舒適和有尊嚴地生活的地方。長期護理 院有時被稱為療養院。
長期護理院提供：
• 24小時院內護理服務
• 由長期護理醫療團隊提供初級保健護理
• 所有膳食（包括對飲食的醫療限制）
• 個人護理方面的日常協助 – 例如洗澡、穿衣和飲食
• 住宿配備基本家具，包括床、椅子和床單
• 洗衣和家務
• 宗教和心靈服務
• 個人衛生用品
• 藥房服務和護理協助，以管理您的藥物和臨床用品
• 社交和娛樂項目
• 安全可靠的環境
• 一些長期護理院還提供短期住宿床位選擇，例如暫托和康復護理
• 社工服務
• 治療服務

我們隨時為您提供幫助。「安省家居保健」組織每個月為全省各地超過400,000名患者協調家居 和社區護理。
我們的使命是通過互聯、便利、以患者為中心的護理，幫助每個人在家裡改善健康。
我們評估患者的護理需求，並提供以家居和社區為基礎的服務以支持您的健康和福祉。我們還提 供社區其他服務的獲取和轉介，並管理安大略省長期護理院的申請和入院流程。
我們與安大略省衛生團隊、家庭醫生、醫院和許多其他衛生系統合作夥伴合作，以支持高質 量、綜合性的護理規劃和服務。

Champlain, Liste de choix de foyers de soins de longue durée

The following checklist is a reference tool for Ontario Health atHome care coordinators, individuals applying to long-term care and their substitute decision maker(s).
Key items related to the application process are listed below and are to be checked off after the information is provided by the care coordinator to the applicant and/or their substitute decision maker.

Please select up to five long-term care homes from the list below, including those you may be interested in that are located outside of the Champlain region.

Consolidated Home and Community Care Support Services Annual Report, 2023/24 + Q1 2024/25
In 2023/24 and Q1 2024/25, Home and Community Care Support Services focused on delivering on our mandate, while making progress in achieving our Annual Business Plan goals. We refined and streamlined processes in anticipation of our amalgamation to form a unified organization.

Completed by a Primary Care Physician or Registered Dietician

Acute Care to Rehab & Complex Continuing Care (CCC) Referral
Referrals are coordinated by Ontario Health atHome Waterloo Wellington. Your health care team will be sharing your
medical and personal information with Ontario Health atHome WW and the rehabilitative care program. Ontario Health
atHome WW will add your name to the waiting list. Your initials and gender will be accessible to Ontario Health atHome
WW’s other hospital partners
Fax Completed Form to 519-742-0635

356 Oxford Street West London, ON N6H 1T3
Telephone: 1-877-900-5667 Fax: 519-657-4578

Telehomecare is a six-month program designed to support patients with self management of congestive heart failure and chronic obstructive pulmonary disease through remote monitoring, coaching, and education provided by specially trained nurses.

Please fax to: 807.767.6968 or 1.855.272.6025
If required, Telehomecare staff will fax the referral form to the Primary Care Provider to verify and/or add any relevant information.

Your Health Passport is for you and your family and/or caregiver. It contains information that is important to you, your condition and treatments as you begin managing your wound. Inside you will find forms and tables that will become a daily log as you move through caring for your wound.
Make sure you bring this passport with you to all your medical appointments/ procedures.

Votre Passeport santé sert à vous, à votre famille ou à la personne qui vous aide. Il contient des informations importantes pour votre santé, votre problème médical et vos traitements alors que vous commencez à traiter votre plaie. Ci-après, vous trouverez des formulaires et des tableaux qui deviendront votre
registre quotidien des soins que vous apporterez progressivement à votre plaie. N’oubliez pas d’apporter ce passeport avec vous à tous vos rendez-vous médicaux et à toutes vos séances de traitement

Cette brochure vous aidera à :
• vous occuper de votre plaie chez vous;
• rehausser et conserver votre santé et votre qualité de vie;
• prévenir de nouvelles plaies.
Vous pouvez utiliser cette brochure et le passeport qui l’accompagne pour :
• noter les informations au sujet de vos soins;
• guider les soins quotidiens que vous apportez à votre plaie;
• savoir quand vous devriez téléphoner à votre équipe; et
• vous assurer que vous recevez les meilleurs soins possible pour votre plaie.

This booklet will help you:
• Manage your wound at home,
• Improve and maintain your health and quality of life,
• Prevent new wounds.
You can use this booklet and the accompanying passport to:

• Keep track of information about your care,
• Guide your day-to-day wound care,
• Know when you need to call your care team,
• Ensure that your wound is being managed in the best way possible.

Cette brochure vous aidera à :
• vous occuper de votre plaie chez vous;
• rehausseret conserver votre santé et votre qualité de vie;
• prévenir de nouvelles plaies.
Vous pouvez utiliser cette brochure et le passeport qui l’accompagne pour :

• noter les informations au sujet de vos soins;
• guider les soins quotidiens que vous apportez à votre plaie;
• savoir quand vous devriez téléphoner à votre équipe;
• vous assurer que vous recevez les meilleurs soins possible pour votre plaie.

This booklet will help you:
• Manage your wound at home,
• Improve and maintain your health and quality of life,
• Prevent new wounds.
You can use this booklet and the accompanying passport to:
• Keep track of information about your care,
• Guide your day-to-day wound care,
• Know when you need to call your care team,
• Ensure that your wound is being managed in the best way possible.

Cette brochure vous aidera à :
• vous occuper de votre plaie chez vous;
• rehausseret conserver votre santé et votre qualité de vie;
• prévenir de nouvelles plaies.
Vous pouvez utiliser cette brochure et le passeport qui l’accompagne pour :
• noter les informations au sujet de vos soins;
• guider les soins quotidiens que vous apportez à votre plaie;
• savoir quand vous devriez téléphoner à votre équipe;
• vous assurer que vous recevez les meilleurs soins possible pour votre plaie.

The senior support team respects and values the dignity of all persons. We are sensitive to issues of diversity in background, social status, abilities and sexual orientations. waterloo wellington

This booklet will help you:
• Manage your wound at home,
• Improve and maintain your health and quality of life,
• Prevent new wounds.
You can use this booklet and the accompanying passport to:

• Keep track of information about your care,
• Guide your day-to-day wound care,
• Know when you need to call your care team,
• Ensure that your wound is being managed in the best way possible

Cette brochure vous aidera à :
• vous occuper de votre plaie chez vous;
• rehausseret conserver votre santé et votre qualité de vie;
• prévenir de nouvelles plaies.
Vous pouvez utiliser cette brochure et le passeport qui l’accompagne pour :

• noter les informations au sujet de vos soins;
• guiderles soins quotidiens que vous apportez à votre plaie;

• savoir quand vous devriez téléphoner à votre équipe;

• vous assurer que vous recevez les meilleurs soins possible pour votre plaie.

This booklet will help you:
• Manage your wound at home,
• Improve and maintain your health and quality of life,
• Prevent new wounds.
You can use this booklet and the accompanying passport to:

• Keep track of information about your care,
• Guide your day-to-day wound care,
• Know when you need to call your care team,
• Ensure that your wound is being managed in the best way possible.

Cette brochure vous aidera à :
• vous occuper de votre brûlures chez vous;
• rehausser et conserver votre santé et votre qualité de vie;
Vous pouvez utiliser cette brochure et le passeport qui l’accompagne pour :

• noter les informations au sujet de vos soins;
• guider les soins quotidiens que vous apportez à votre brûlures;
• savoir quand vous devriez téléphoner à votre équipe;
• vous assurer que vous recevez les meilleurs soins possible pour votre brûlures

This booklet will help you:
• Manage your burn at home,
• Improve and maintain your health and quality of life,
You can use this booklet and the accompanying passport to:

• Keep track of information about your care,
• Guide your day-to-day wound care,
• Know when you need to call your care team,
• Ensure that your burn is being managed in the best way possible.

Cette brochure vous aidera à :
• à prendre soin de votre stomie chez vous;v
• à améliorer et à maintenir votre santé et votre qualité de vie.
Vous pouvez utiliser cette brochure et le passeport qui l’accompagne pour :

• noter les informations au sujet de vos soins;
• trouver réponse aux questions liées à votre stomie;
• savoir quand vous devriez téléphoner à votre équipe;
• vous assurer que vous recevez les meilleurs soins possible pour votre stomie.

This booklet will help you:
• Manage your ostomy at home,
• Improve and maintain your health and quality of life,
You can use this booklet and the accompanying passport to:

• Keep track of information about your care,
• Answer questions you may have about your ostomy,
• Know when you need to call your care team,
• Ensure that your ostomy is being managed in the best way possible

Cette brochure vous aidera à :
• vous occuper de votre plaie chez vous;
• rehausser et conserver votre santé et votre qualité de vie;
• prévenir de nouvelles plaies.

This booklet will help you:
• Manage your wound at home,
• Improve and maintain your health and quality of life,
• Prevent new wounds.

Cette brochure vous aidera à :
• vous occuper de votre plaie chez vous;
• rehausser et conserver votre santé et votre qualité de vie;
• prévenir de nouvelles plaies

This booklet will help you:
• Manage your wound at home,
• Improve and maintain your health and quality of life,
• Prevent new wounds.

Si vous envisagez d’acheter ou d’emprunter un fauteuil, veuillez tenir compte des caractéristiques suivantes :
• Choisir un fauteuil dont la hauteur (du plancher au dessus du siège) est aussi élevée que possible tout en vous permettant de poser vos pieds au sol confortablement.
• Choisir un fauteuil dont les bras sont assez élevés et assez près de votre corps pour que vous puissiez vous en servir pour vous aider à vous lever.
• Éviter les fauteuils à bascule, à roulettes ou à pivot, car ces mécanismes rendent le fauteuil instable lorsqu’on s’appuie dessus pour se lever.
• Éviter les fauteuils dont le siège penche beaucoup vers le dossier, car cela abaisse le siège et il est alors plus difficile de se lever.

Use this guide if you are considering buying or borrowing a chair. Updated June 28, 2024

Venous Leg Ulcer (VLU): Characterized by edema of the legs with shallow irregular shaped wound(s) typically occurring on the medial or lateral distal lower leg. The ulcer is usually red but can also contain slough, yellow film or fibrin. Etiology of VLU is chronic venous hypertension. The failure of valves in the veins and/or ineffective calf muscle pump results in inadequate venous return from the legs

Traumatic Wound: Includes lacerations, abrasions and penetrating injuries, and usually involves skin/tissue being ripped or torn. These wounds often involve foreign bodies (gravel, glass, etc.) and are prone to infections

Surgical Site Complication: Any surgical wound that is not healing by primary intention and/or within an expected timeframe due to one or more complications i.e. infection, dehiscence, etc.
Note: Surgical wounds deemed “non-healable” should follow the Chronic Maintenance/Non Healing Wound ICP.

Pressure Injury: Localized damage to the skin and underlying tissue occurring as a result of intense and/or prolonged pressure with or without shear.
PRESSURE INJURY CLASSIFICATION:
– STAGE I – Patients identified as being at risk for the development of a pressure injury or intact skin with reddened area non-blanchable-
STAGE II – partial thickness loss of dermis presenting as shallow open injury with a pink red wound bed without slough, may also present as an intactor
open/ruptured serum filled blister
– STAGE III – full thickness skin loss, subcutaneous fat may be visible; but bone, tendon, or muscle are not; slough may be present but does not obscure the depth of tissue loss. May include undermining or tunneling
– STAGE IV – full thickness skin loss, with exposed muscle, tendon, or bone. Slough or eschar may be present, often includes undermining or tunneling.
– UNSTAGEABLE – Full thickness tissue loss in which the base of the injury is covered by slough and/or eschar in the wound bed
– DEEP TISSUE INJURY (DTI) – purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or sheer

Partial Thickness Burns (PTB): PTB can involve the epidermis and dermis and are characterized by pain, redness, edema &blistering. PTB can be life-threatening depending on age, comorbidities and the extent of the body surface involved. These burns can often be managed safely in the community or out-patient setting and may require hospitalization from time to time.
Full Thickness Burns: Destroy the epidermis, dermis and capillary network. Skin grafting may be required. They are typically managed in an acute care burn unit setting

Ostomy: An ostomy refers to a surgical opening in the abdomen, known as a stoma. The purpose of the ostomy is to divert waste out of the body through the stoma. The four most commonly encountered ostomies are as follows:
1. Colostomy – stoma is created when a section of the large intestine is brought to the surface of the abdomen. Output can vary from liquid or past-like stool to formed stool, with or without the presence of gas, depending on the type of colostomy.
2. Ileostomy – stoma is created when a section of the small intestine is brought to the surface of the abdomen. Output is dark green and will range in consistency from liquid to mushy, with gas.
3. Urostomy or ileal conduit – urine is diverted away from the bladder and expelled from the body through the stoma. Output is urine for a urostomy, and urine with mucous for an ileal conduit.
4. Mucous Fistula – stoma is created when two ends of the bowel are brought to the surface of the abdomen. Mucous created by the disconnected end of the bowel is released through one stoma, the mucous fistula.

Diabetic Foot Ulcer (DFU): DFU is a complication of diabetes mellitus characterized by a partial or full-thickness open wound with or without discharge. Cracks, fissures, or ulcers form as a result of acute trauma, callous formation, or repeated/persistent trauma. DFU may be complicated by pain and/or neuropathy.
Neuropathic Foot Ulcer: Neuropathic foot ulcers can occur in the absence of diabetes.

Acute Surgical Wound: Acute surgical wounds heal within an expected timeframe and without complications

Abscess: Collection of pus within inflamed tissue frequently caused by bacterial infection. The infection often damages the surrounding tissue creating a cavity.
Incision & Drainage: Common treatment for cysts or abscesses (including pilonidal sinus wounds) may include incision and drainage, where the abscess is incised and the debris is drained.
Pilonidal Sinus Wound: A pilonidal sinus wound is a cyst or abscess located near or at the natal cleft of the buttocks and often contains hair and skin debris.

Please fax referral forms to: 705-670-3805
If required, Telehomecare staff will fax the referral form to the Primary Care Provider to verify and/or provide any relevant information.
Updated: June 28, 2024

GENERAL INFORMATION & QUESTIONNAIRE. Updated June 28, 2024

Medical Equipment Vendor Order Trackers allow you to track orders with:
Medigas: Central, Central West, Mississauga Halton, North Simcoe Muskoka, Toronto Central, North East and North West
Ontario Medical Supply: Central East, Champlain and South East
Rexall: Erie St. Clair, Hamilton Niagara Haldimand Brant, South West and Waterloo Wellington

Revised: June 5, 2025

NOTE: A current medication list is recommended with each referral. You may use this form or provide a current medication list using your. own agency-specific/primary care provider’s form if it contains the following information. For additional notes fill out this form. Updated June 28, 2024

This form is additional Notes relating to the Referral for Services form. Updated: June 28, 2024

Referral for Central Venous Access Device (CVAD) Through Regional Cancer Program form. Updated June 2024

*Not a pathway or wound type – use guidelines when NPWT is initiated in conjunction with pathway that is appropriate for wound type.

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.
Fax: 613-745-6984/1-855-450-8569
*Hospital: Use hospital Ontario Health atHome fax number

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.

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.

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.

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.

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.

Fax: 905-855-8989 / 1-877-298-8989
*Hospital: Use hospital Ontario Health atHome fax number

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.

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. Form CS 570 OC 24

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.

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.

Note: This form will be effective on July 23, 2024.

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.

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.

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.

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.

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

Order form for supplies and equipment needed for Negative Pressure Wound Therapy in the Central West area

Complete the Burlington IPCOT referral form and fax supporting documents to: 905-574-6335
– Medical summary/ health history
– Pertinent diagnostic tests
– Current medication lists
– Pharmacy information
– Consult/ progress notes
– Other notes

Le Programme communautaire de réadaptation après un accident vasculaire cérébral est conçu pour vous aider à vous rétablir, à adapter votre domicile selon vos nouveaux besoins et à obtenir d’autres services dont vous pourriez avoir besoin.

The Community Stroke Rehabilitation Program is designed to help you through recovery, ensure your home environment is adapted to meet your new needs and connect you to other services you may require.

Veuillez suivre ces instructions (S’ouvre dans un nouvel onglet)
pour accéder au formulaire.

Formulaire fourni par le ministère des Soins de longue durée en vertu de la Loi de 2021 sur le redressement des soins de longue durée.

Si vous souhaitez être admis dans un foyer de soins de longue durée (SLD), vous devez remplir ce formulaire. Ces renseignements sont requis par Santé à domicile Ontario, le coordonnateur du placement désigné pour les foyers de SLD, afin de déterminer si vous êtes admissible à l’admission. Santé à domicile Ontario peut recueillir d’autres renseignements personnels sur la santé auprès de vos fournisseurs de soins de santé afin de déterminer votre admissibilité. Santé à domicile Ontario peut également utiliser et divulguer les renseignements aux mêmes fins.
Renseignements sur le demandeur

Important Note: Please follow these instructions (opens in a new tab) to access the form.

Form provided by the Ministry of Long-Term Care under the Fixing Long-Term Care Act, 2021.

If you wish to be admitted to a long-term care (LTC) home, you must fill out this form. This information is required by Ontario Health atHome, the designated placement co-ordinator for LTC homes, to determine if you are eligible for admission. Ontario Health atHome may collect additional personal health information from your health care providers
for the purpose of determining your eligibility. Ontario Health atHome may also use and disclose the information for the same purpose.

To receive this document in an alternate format at no cost, please contact Ontario Health atHome’s Communications Team by the means listed below:

Email: accessibility@ontariohealthathome.ca
Phone: 310-2222
TTY: 711

Ontario Health atHome Posting of Travel, Meal and Hospitality.
Executive Expense Report for Designated Individuals for Quarter 4 – Fiscal Year 2024-25

Ontario Health atHome Posting of Travel, Meal and Hospitality.
Executive Expense Report for Designated Individuals for Q3 2024-25

Ontario Health atHome Posting of Travel, Meal and Hospitality Board of Directors Expense for Quarter 4 – Fiscal Year 2024/25

The Expected Death in the Home (EDITH) protocol supports end-of-life care based on an individual’s expressed wish to die at home and not to be resuscitated when they stop breathing or their heart stops. An expected death refers to when, in the opinion of a health care team, the patient is irreversibly and irreparably terminally ill; that is, there is no available treatment to restore health, or the patient refuses the available treatment.

The Short-Term Transitional Care Unit (TCU) Program is a collaborative initiative co-developed with the clinical leadership of Ontario Health atHome and CareKW. Our shared objective is to provide patients with a supportive environment where they can receive the necessary care to facilitate their transition to an alternative living arrangement that aligns with their care needs.

The submission of this completed form for nursing and supplies facilitates the delivery of the MAiD kit (i.e., supplies only and no medications) to the location you identify below, where the MAID procedure will take place.

The Expected Death in the Home (EDITH) protocol supports end-of-life care based on an individual’s expressed wish to die at home and not to be resuscitated when they stop breathing or their heart stops. An expected death refers to when, in the opinion of a health care team, the patient is irreversibly and irreparably terminally ill; that is, there is no available treatment to restore health, or the patient refuses the available treatment.

Public organizations, non-profits, and private businesses must complete an AODA (opens in a new tab) compliance report. This report is a way to make sure that organizations are on track with the goal of making a fully accessible province by 2025. This report confirms that businesses have met their AODA needs (opens in a new tab) .

In 2005, the government of Ontario passed the Accessibility for Ontarians with Disabilities Act (AODA), which requires that Ontario be an accessible province by 2025.
Accessibility standards have been created as part of the Accessibility for Ontarians with Disabilities Act. These standards are rules that businesses and organizations in Ontario need to follow to identify, remove and prevent barriers so that people with disabilities have more opportunities to participate in everyday life.

To ensure compliance with the Ontario Health atHome in the area of North West duty to accommodate disability and maintain an environment of equal opportunity and treatment.
SCOPE:
This policy applies to all employees in all employment categories, full-time regular, part-time regular, contract, student and intern, board members, and volunteers. This policy is intended to supplement Collective Agreement Language, and will not contradict or supersede such language. Where Collective Agreement Language is absent, this policy will govern.

Important Note: Please follow these instructions (opens in a new tab) to access the report.

Public organizations, non-profits, and private businesses must complete an AODA (opens in a new tab) compliance report. This report is a way to make sure that organizations are on track with the goal of making a fully accessible province by 2025. This report confirms that businesses have met their AODA needs (opens in a new tab) .

Important Note: Please follow these instructions (opens in a new tab) to access the report.

Public organizations, non-profits, and private businesses must complete an AODA (opens in a new tab) compliance report. This report is a way to make sure that organizations are on track with the goal of making a fully accessible province by 2025. This report confirms that businesses have met their AODA needs (opens in a new tab) .

Important Note: Please follow these instructions (opens in a new tab) to access the report.

Public organizations, non-profits, and private businesses must complete an AODA (opens in a new tab) compliance report. This report is a way to make sure that organizations are on track with the goal of making a fully accessible province by 2025. This report confirms that businesses have met their AODA needs (opens in a new tab) .

The Ontario Health atHome in the area of North West is required to meet obligations under the Accessibility for Ontarians with Disabilities Act, 2005 (AODA). The purpose of the Act is to develop, implement and enforce accessibility standards in order to achieve accessibility for persons with disabilities with respect to goods, services, facilities, accommodation, employment, buildings, structures and premises.
This policy is intended to meet the requirements of the Customer Service Standard, the Information and Communications Standard, the Employment Standard, and components of the Design of Public Spaces Standard, included in the Integrated Accessibility Standards under the Accessibility for Ontarians with Disabilities Act, 2005.

Important Note: Please follow these instructions (opens in a new tab) to access the report.

Public organizations, non-profits, and private businesses must complete an AODA (opens in a new tab) compliance report. This report is a way to make sure that organizations are on track with the goal of making a fully accessible province by 2025. This report confirms that businesses have met their AODA needs (opens in a new tab) .

Important Note: Please follow these instructions (opens in a new tab) to access the report.

Public organizations, non-profits, and private businesses must complete an AODA (opens in a new tab) compliance report. This report is a way to make sure that organizations are on track with the goal of making a fully accessible province by 2025. This report confirms that businesses have met their AODA needs (opens in a new tab) .

Important Note: Please follow these instructions (opens in a new tab) to access the report.

Public organizations, non-profits, and private businesses must complete an AODA (opens in a new tab) compliance report. This report is a way to make sure that organizations are on track with the goal of making a fully accessible province by 2025. This report confirms that businesses have met their AODA needs (opens in a new tab) .

Important Note: Please follow these instructions (opens in a new tab) to access the report.

Public organizations, non-profits, and private businesses must complete an AODA (opens in a new tab) compliance report. This report is a way to make sure that organizations are on track with the goal of making a fully accessible province by 2025. This report confirms that businesses have met their AODA needs (opens in a new tab) .

Important Note: Please follow these instructions (opens in a new tab) to access the report.

Public organizations, non-profits, and private businesses must complete an AODA (opens in a new tab) compliance report. This report is a way to make sure that organizations are on track with the goal of making a fully accessible province by 2025. This report confirms that businesses have met their AODA needs (opens in a new tab) .

Important Note: Please follow these instructions (opens in a new tab) to access the report.

Public organizations, non-profits, and private businesses must complete an AODA (opens in a new tab) compliance report. This report is a way to make sure that organizations are on track with the goal of making a fully accessible province by 2025. This report confirms that businesses have met their AODA needs (opens in a new tab) .

Important Note: Please follow these instructions (opens in a new tab) to access the report.

Public organizations, non-profits, and private businesses must complete an AODA (opens in a new tab) compliance report. This report is a way to make sure that organizations are on track with the goal of making a fully accessible province by 2025. This report confirms that businesses have met their AODA needs (opens in a new tab) .

Les coordonnateurs des soins vous aident, vous et votre famille, dans le processus d’admission en foyer de soins de longue durée. Lorsque vous faites une demande d’admission, nous vous encourageons à choisir cinq maisons. On vous proposera le premier disponible.

Ontario Medical Supply (OMS) Medical Equipment Catalogue for the following areas: Cental East, Champlain and South East
March 2025

Rexall Medical Equipment Catalogue for the following area: Erie St. Clair, Hamilton Niagara Haldimand Brant, South West and Waterlook Wellington

March 2025

La sécurité des patients est notre priorité absolue. La présente feuille de renseignements a pour objet d’aider les patients, leur famille et leurs soignants à comprendre l’importance de la sécurité des lits ainsi que les risques qui s’y rattachent, notamment le piégeage.
Si vous avez des questions ou des préoccupations au sujet de la sécurité des lits, parlez-en à votre coordonnateur ou coordonnatrice de soins.

Patient safety is our top priority. This information sheet is to help patients, families and caregivers understand bed safety and risks, including entrapment.
If you have any bed safety questions or concerns, please speak with your Care Coordinator.

Referral/Request for Assessment in South West area. This is a PDF Interactive form. You have the option to complete all or parts, electronically. When completed, please print ad return this form to Ontario Health atHome via fax.
London: 519-472-4045 (patients living in London/Middlesex and Elgin)
Stratford: 519-273-2847 or toll free: 1-855-223-2847 (patients living in Grey/Bruce, Huron, Oxford, Perth)

Contract Stream Implementation for Medical Equipment
Frequently Asked Questions for Health System Partners

356 Oxford Street West London, ON N6H 1T3
Telephone: 1-855-474-5754 Fax: 519-472-3257
** Orders with less than 48 hours notice require a call to 519-474-5754 to confirm**
For support, or to ensure receipt of a new order sent between 2:00 pm Friday and 8:00 am Monday (and holidays), please call 519-474-5754

Completed by Primary care Physician to request Home Care services. Patient/Families may also print this referral form to bring to an appointment for completion.
If initiating referral for HPC services, please use Form 031B, “Request for Hospice Palliative Care Services”

We’re here to help. Ontario Health atHome coordinates in-home and community-based care for over 400,000 patients across the province every month.
Our mission is to help everyone be healthier at home through connected, convenient and accessible patient-centred care.
This booklet is a guide to our home and community care services and includes other important information related to patient care. Patients are encouraged to share this information with their family members or caregivers who will be involved in their care.

2022-2023 Audited Financial Statements – English

Enabling students with medical needs to succeed in education
Ontario Health atHome’s School Health Support Services program is designed to support children with medical needs – whether a short or long-term illness, physical disability, medically complex condition or requiring assistance following an injury or hospital stay.

Fax: 905-855-8989 / 1-877-298-8989

*Hospital: Use hospital Ontario Health atHome fax number

Ontario Health atHome Posting of Travel, Meal and Hospitality Board of Directors Expense for Quarter 3 – Fiscal Year 2024/25

Multi-factor authentication (MFA; two-factor authentication, or 2FA, along with similar terms) is an electronic authentication method in which a user is granted access to a website or application only after successfully presenting two or more pieces of evidence (or factors). MFA helps protect personal data from being accessed by an unauthorized party by adding an additional layer of protection to traditional passwords. This guide covers how to use one method of MFA, Microsoft Authenticator.

Toronto Fax: (416) 222-6517
Newmarket Fax: (905) 952-2404

Please complete and fax order form to Ontario Health atHome: 519-472-4045 or 1-855-539-6970
For any additional inquiries please call Ontario Health atHome at 1-855-474-5754

Note: A signed prescription for feed including type and rate, as well as a completed Nutrition Products Form
from the physician must be faxed to the pharmacy providing the feed.
Fax: 519-472-4045

Note: A signed prescription for feed including type and rate, as well as a completed Nutrition Products
Form from the physician must be faxed to the pharmacy providing the feed.
Fax: 519-472-4045

SRK is a temporary or short term solution only.

• The SRK are MD/NP orders to be implemented by a nurse (RN, RPN) when symptoms require urgent intervention to manage acute symptoms and facilitate a comfortable death at home.
• The MRP/NP is to be notified as soon as possible regarding changes in condition necessitating the initiation of orders.
• ALL requested medications must be checked off in the form.

Please fax back to ontario health athome 705‐792‐6270

Care coordinators assist you and your family in the long-term care home admission process. When you apply for admission, you are encouraged to choose five homes. You will be offered the first one available. Ask your care coordinator for information about long-term care homes in other counties in South West Ontario.

Trouver les coordonnées de votre région par:

• Dossiers de santé
• Bureau de la protection de la vie privée
• Coordonnateur de l’accès à l’information

Find contact information for your local:

• Health Records
• Privacy Office
• Freedom of Information Coordinator

TO ALL PALLIATIVE CARE PROVIDERS
(For the purpose of this form, an individual refers to a patient or client)
Your submission of this form will be taken to explicitly mean that you have gained appropriate permission for release of the information contained to the agencies and services to whom you are submitting this. Please also include your Organization’s Release of Information Form, if applicable.

Ontario Health atHome Child and Youth Mental Health & Addictions Nursing Program
Fax: 1 (519) 571-3957
A mental health nurse will connect with student, parent and/or guardian to confirm consent and finalize eligibility.

Ontario Health atHome Child and Youth Mental Health & Addictions Nursing Program
Fax: 1 (519) 571-3957
A MH nurse will connect with student, parent and/or guardian to confirm consent and finalize eligibility.

Permettre aux élèves ayant besoin de soins médicaux de réussir à l’école
Le programme de Services auxiliaires de santé dans les écoles de Santé à domicile Ontario a été conçu pour soutenir les enfants ayant besoin de soins médicaux en raison d’une maladie de courte ou de longue durée, d’un handicap physique ou d’un problème de santé complexe et ceux qui ont besoin d’aide après une blessure ou une hospitalisation récente.

Dans le cadre du Programme de reconnaissance de soignants « Au-delà du devoir », on célèbre et honore une fois par année les soignants (membres de la famille, amis et voisins, entre autres) dont la gentillesse, le dévouement et le soutien permettent aux gens de vivre à la maison, malgré les problèmes liés à la vieillesse, à une maladie ou à un handicap. L’objectif du programme est de reconnaître les soignants en Ontario qui incarnent les valeurs de Santé à domicile Ontario, soit la collaboration, le respect, l’intégrité et l’excellence.

The annual Above and Beyond Caregiver Recognition Program celebrates and honours caregivers (family members, friends, neighbours, etc.) whose kindness, dedication, and support enables people to live at home despite the impacts of age, illness or disability. The program is designed to recognize caregivers that live the Ontario Health atHome Values of collaboration, respect, integrity and excellence.

Ontario Health atHome is commited to identifying, removing and preventng barriers to accessibility and improving opportunities for people with disabilities. Progress towards the goals identified in the multi-year accessibility plan, are outlined in this Annual Status Report.

The purpose of this policy is to outline the practices and procedures in place at Ontario Health atHome (OHaH) to help identify and remove barriers that impede a person’s ability to access care and services. This includes clients, customers, families, staff and members of Ontario Health atHome communities.

Ontario Health atHome is dedicated to assisting people access the care they need by providing them with home and community health care services. Through our vision of Healthy People. Thriving Communities. Bright Futures, we realize the promise of quality care provision for our residents.

Santé à domicile Ontario exploite plus de 135 cliniques de soins infirmiers communautaires, fournissant des soins infirmiers spécialisés de haute qualité, sans frais.
Nos cliniques sont à des endroits accessibles, sur rendez-vous seulement, mais nombreuses parmi elles ont des heures d’ouverture prolongées

Ontario Health atHome operates over 135 community nursing clinics to provide free, high-quality, specialized nursing care.
All of our clinics are by appointment only, in accessible locations, and many have extended operating hours.

Veuillez utiliser la liste de vérification qui suit pour bien gérer votre santé et savoir où aller pour obtenir des soins au cours de l’automne, de l’hiver et de la période des Fêtes.

Please use the following checklist to help you be prepared to manage your health and know where to get care during the fall, winter and holiday periods.

POLICY

1. This is a Physician / Nurse Practitioner (NP) order to be implemented by a Registered Nurse (RN) / Registered Practical Nurse (RPN) when
   symptoms require urgent intervention to facilitate a comfortable home death.
2. The attending Physician/NP is to be notified as soon as possible regarding change in patient’s condition and need for ongoing prescription(s).
3. DNR and plan for expected death should be in place.
4. Completed prescription to be FAXED back to Ontario Health atHome at 416-222-6517 or 905-952-2404

If required, Telehomecare staff will fax the referral form to the Primary Care Provider to verify and/or provide any relevant information.
Chatham Branch: Fax: 519-351-5842
Sarnia Branch: Fax: 519-337-4331
Windsor Branch: Fax: 519-258-6288

This form is to be completed by the School Staff or Hospital Staff referring student. Submit the completed form (page 1) to the
fax number or email address listed on the form
Please Fax Completed Referral To: (905) 952-2407 or Email To: MHAN@ontariohealthathome.ca
Phone: 905-895-1240 or 416-222-2241 or 1-888-470-2222 Ext. 436525

Le programme intégré d’aide à la vie autonome pour personnes âgées vous permet d’obtenir le soutien dont vous avez besoin pour vivre de façon autonome chez vous.

• Un coordonnateur de soins peut vous obtenir l’aide dont vous avez besoin pour vos soins personnels et vos tâches quotidiennes.
• Si vous rentrez à la maison après une hospitalisation, un coordonnateur de soins peut aussi vous aider à obtenir les services de soutien à la personne et les services communautaires de soutien dont vous avez besoin.
• Les services de soutien à la personne qui sont organisés par l’intermédiaire Services de soutien à domicile et en milieu communautaire Waterloo Wellington sont gratuits.

The Integrated Assisted Living Program for seniors will help you live independently at home with the support you need.

• A care coordinator can connect you to the help you need for personal care and everyday tasks.
• If you are returning home following a hospital stay, a care coordinator can also help you get the personal care and community support you need.
• There is no cost to you for the personal support services that are arranged through Ontario Health atHome.

CPS fax: 1-866-675-0885
*Hospital: Use hospital Ontario Health atHome fax number

Veuillez remplir le présent formulaire et le soumettre, en y joignant une facture (les reçus ne sont pas exigés), par l’un des moyens suivants afin d’obtenir le remboursement de vos dépenses liées aux fournitures médicales.
Courriel : refund@ontariohealthathome.ca
Envoi postal : Santé à domicile Ontario, 11 Allstate Parkway, bureau 500, Markham (Ontario) L3R 9T8 Attention : Remboursement des dépenses liées aux fournitures médicales

Ontario Health atHome Posting of Travel, Meal and Hospitality Executive Leadership Expense for Quarter 2 – Fiscal Year 2024/25

Home and Community Care Support Services Posting of Travel, Meal and Hospitality Executive Leadership Expense for Quarter 1 – Fiscal Year 2024/25

Ontario Health atHome Posting of Travel, Meal and Hospitality Board of Directors Expense for Quarter 2 – Fiscal Year 2024/25

Les coordonnateurs des soins vous aident, vous et votre famille, dans le processus d’admission en foyer de soins de longue durée. Lorsque vous faites une demande d’admission, nous vous encourageons à choisir cinq maisons. On vous proposera le premier disponible.

Les coordonnateurs des soins vous aident, vous et votre famille, dans le processus d’admission en foyer de soins de longue durée. Lorsque vous faites une demande d’admission, nous vous encourageons à choisir cinq maisons. On vous proposera le premier disponible.
Avant de présenter votre demande, assurez-vous de visiter les maisons qui vous intéressent. C’est à vous de faire des arrangements de visite en contactant directement les maisons. Des visites vidéo des foyers de soins de longue durée peuvent être visionnées à l’adresse www.lignesantéSud-Ouest.ca (S’ouvre dans un nouvel onglet) .

Care coordinators assist you and your family in the long-term care home admission process. When you apply for admission, you are encouraged to choose five homes. You will be offered the first one available.

Care coordinators assist you and your family in the long-term care home admission process. When you apply for admission, you are encouraged to choose five homes. You will be offered the first one available.

Santé àdomicile Ontario signe une entente contractuelle avec tous les patients du Programme de soins àdomicile gérés par la famille. Dans cette entente, on présente les détails les plus importants tels que le plan de soins du patient, les exigences en matière de présentation de rapports mensuels ainsi que des données financières.

• La nouvelle entente contractuelle comporte le versementd’un dépôt le premier jour de chaque mois.
• Les patients n’ont plus àpayer de leur poche pour lesservices de soins àdomicile.
• Ils doivent présenter des rapports mensuels.

Every patient on Family-Managed Home Care has a contract with Ontario Health atHome that outlines key details like the patient care plan, monthly reporting requirements and financial details.

• The new contract features pre-flowed funding on thefirst day of each month
• Patients no longer need to pay out-of-pocket for homecare services
• Required to submit monthly reporting documents

Wound Care and General Supply Order Form for Central West area

Respiratory Therapy Supply Order Form for Central West area

Ostomy Supply Order Form for Central West area

Fax: 905-855-8989 / 1-877-298-8989

*Hospital: Use hospital Ontario Health atHome fax number

Fax: 905-855-8989 / 1-877-298-8989

*Hospital: Use hospital Ontario Health atHome fax number

Fax: 905-855-8989 / 1-877-298-8989

*Hospital: Use hospital Ontario Health atHome fax number

Windsor Regional Hospital – Ouellette Campus inpatient referral and treatment form

Chatham Site – Fax: 519-351-5842
Sarnia Site – Fax: 519-337-4331
Windsor Site – Fax: 519-258-6288

Medical Supply Reimbursement Form for Eligible Expenses – English – Fillable

Le présent accord a pour but d’établir les conditions générales selon lesquelles Santé Ontario fournira
un financement à Santé à domicile Ontario, afin de lui permettre de s’acquitter de ses obligations en
vertu du présent Accord et de remplir ses obligations légales en vertu de la Loi pour des soins de santé
connectés (CCA). Le présent Accord constitue un accord de responsabilisation de service tel que défini
dans la Loi pour des soins de santé connectés (CCA).

The purpose of this agreement is to set out the terms and conditions on which Ontario Health will provide funding to Ontario Health atHome, to enable Ontario Health atHome to perform its obligations under this Agreement and fulfills its statutory obligations under the Connection Care Act. This Agreement is a service accountability agreement as defined in the Connecting Care Act.

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

Après un séjour en milieu hospitalier, de nombreux patients peuvent continuer de se rétablir en toute sécurité dans le confort de leur maison en recevant des services de soins à domicile appropriés. Sous le titre « Chez soi avant tout », cette approche met en priorité la santé et la sécurité des patients, permettant de veiller à ce que chaque personne reçoive les bons soins, au bon moment et au bon endroit.

After hospital stays, many patients can continue their recovery safely in the comfort of their home with appropriate home care services. This approach to care is called Home First, with patient health and safety as the top priority, ensuring each person receives the right care at the right time and in the right place.
Based on your circumstances, your health care team has determined that the acute care portion of your hospital stay is complete and that you can benefit from home care services to help your safe transition from hospital.

Formulaire de demande de services

Envoyez par fax au : 613 745-8243 ou 1 855 450-8569

Through our Available Retirement Care Home Enhanced Supports (ARCHES) to Care Beds Program, we are able to help you move from the hospital to a retirement residence with enhanced supports where you can make important decisions about your future care and living arrangements.

Sommaire du processus de demande au Programme de soins à domicile gérés par la famille
Grâce au Programme de soins à domicile gérés par la famille, les patients et les mandataires spéciaux admissibles reçoivent du financement pour embaucher des fournisseurs de services de soins et payer leurs services de soins à domicile. L’équipe peut, à tout moment, répondre aux questions que vous pouvez avoir au sujet du programme ou de votre admissibilité.
Si vous voulez en savoir plus, visitez la page web : Soins à domicile gérés par la famille.

Through the Family-Managed Home Care program, eligible patients or their substitute decision makers, receive funding to purchase home care services or employ care providers. The team can answer any questions you may have about the program or your eligibility at any time.
To learn more, please visit Family-Managed Home Care

Complete the Request for Ontario Health atHome, Hamilton Niagara Haldimand Brant area, services and fax it to the appropriate location. Refer to page 2 of the form for fax numbers.

Primary Care Partners: in addition to using the form above, you may also connect directly with the Care Coordinator aligned with your office/practice.

Statement of financial position for Hamilton Niagara Haldimand Brant as at June 27, 2024

Statement of financial position for Central East as at June 27, 2024

Statement of financial position for Central as at June 27, 2024

Statement of financial position for Champlain as at June 27, 2024

Statement of financial position for Central West as at June 27, 2024

Statement of financial position for Erie St. Clair as at June 27, 2024

Statement of financial position for Mississauga Halton as at June 27, 2024

Statement of financial position for North East as at June 27, 2024

Statement of financial position for North Simcoe Muskoka as at June 27, 2024

Statement of financial position for North West as at June 27, 2024

Statement of financial position for South East as at June 27, 2024