Document Library

Form of Request for Services and Form of Statement of Work (RFS/SOW)

Memorandum of Understanding 2021 HNHB

Note – all medical conditions must be stable and investigations addressed

Note – all medical conditions must be stable and investigations addressed
*Note: Cambridge rehab beds continue to be housed at WRHN @ Chicopee

Ontario Health atHome Posting of Travel, Meal and Hospitality Board of Directors Expense for Quarter 2 – Fiscal Year 2026/27

Ontario Health atHome Posting of Travel, Meal and Hospitality.
Executive Expense Report for Designated Individuals for Quarter 2 – Fiscal Year 2026-27

Effective October 2026
Tel: 905-855-9090 / 1-877-336-9090
Fax: 905-855-8989 / 1-877-298-8989
Send to OHaH MH HPG Central Ordering Inbox

Helping you return to better health
Following surgery or serious illness, you may no longer need in-hospital care but you may not be ready to return home safely.
The Convalescent Care Program provides 24 hour care to people who require specific medical and therapeutic services in a supportive environment.

Please fax this form to: 1 888 499 0555
To contact the ESC Ontario Health atHome call: 1-833-515-1234

Within this report is Ontario Health atHome’s Business Plan for 2025-2028. Our report begins on page 65.

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.

2026-2027 Extension of Annual Price Review, Privacy & Cyber Security

Connecting Care to Home (CC2H) is a two-to-six-week program that supports a safe transition from hospital to home, for those with a diagnosis of Chronic Obstructive Pulmonary Disease (COPD) and/or Congestive Heart Failure (CHF).

To coincide with National Caregiver Day, Ontario Health atHome created the Above and Beyond Caregiver
Recognition Program to recognize, celebrate and support caregivers who make it possible for people to live
their lives in their communities

To be used by all Service Provider Organizations (SPOs) when transferring care.
For personal support: PSS Supervisor to complete form to hand over care to new PSS provider

Service Provider Organizations are required to complete the following referral when referring a patient to Ontario Health
atHome. With this referral, please include assessment information (most recent interRAI HC/CA), updated medical
orders, PSW/nursing/therapy assessments and substitute decision maker (SDM) documentation.

Ontario Health atHome Posting of Travel, Meal and Hospitality.
Executive Expense Report for Designated Individuals for Quarter 1 – Fiscal Year 2026-27

Ontario Health atHome Posting of Travel, Meal and Hospitality Board of Directors Expense for Quarter 1 – Fiscal Year 2026/27

Ontario Health atHome offers evidence-based, best practice wound care in alignment with Ontario Health (formerly Health Quality Ontario) wound care standards and Wounds Canada. Specialized wound care teams that may include Nurse Champions, Nurses Specialized in Wound, Ostomy and Continence, and dedicated wound care coordinators are available to support patients with acute, chronic and complex wounds.

Enjoy the best possible health while staying in your own home
Telehomecare is a free health coaching and remote monitoring program that that can make a real difference in your life. Telehomecare helps people gain control of their Heart Failure.

Enjoy the best possible health while staying in your own home
Telehomecare is a free health coaching and remote monitoring program that can make a real difference in your life. Telehomecare helps people gain control of their COPD – chronic obstructive pulmonary disease – which refers to different types of chronic lung disease, including emphysema.

Statement of financial position for Ontario Health atHome as at March 31, 2026
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.

Prepared in accordance with section 14 of the Broader Public Sector Accountability Act, 2010 (“BPSAA”)

Form # PSR003
Please Note: This form needs to be faxed after sending the referral in Resource Matching and e-Referral (RM&R)

MHRH Fax: (905) 707-241

Please Note: This form needs to be faxed after sending the referral in Resource Matching and e-Referral (RM&R)
Signed Physician/NP Medical Orders are not required for Occupational Therapy, Personal Support and Physiotherapy

Form # PSR003 – Oak Valley Hospital
Please Note: This form needs to be faxed after sending the referral in Resource Matching and e-Referral (RM&R)

Please Note: This form needs to be faxed after sending the referral in Resource Matching and e-Referral (RM&R)
Signed Physician/NP Medical Orders are not required for Occupational Therapy, Personal Support and Physiotherapy

*Requests are only for H2H patients already being supported by H2H program within the community
**Hospital based patients are to be initiated as per hospital Ontario Health atHome processes
Please fax completed form to Ontario Health atHome H2H ODB team at 1-877-546-4311

For Humber River Hospital

For Humber River Hospital
Phone: 416-242-1000 x 21500
Fax: 416-242-1068

Form #PSR003 – Humber River Hospital
Please Note: This form needs to be faxed after sending the referral in Resource Matching and e-Referral (RM&R)

* Complete medical orders for PICC line or Port Flush
For Humber River Hospital

* Complete medical orders for PICC line or Port Flush
For Humber River Hospital

* Complete medical orders for PICC line or Port Flush
For Humber River Hospital

* Complete medical orders for PICC line or Port Flush
For Humber River Hospital

Form #PSR003 – Humber River Hospital
Please Note: This form needs to be faxed after sending the referral in Resource Matching and e-Referral (RM&R)

Form #PSR003 – Humber River Hospital
Please Note: This form needs to be faxed after sending the referral in Resource Matching and e-Referral (RM&R)

Form #PSR003 – Humber River Hospital
Please Note: This form needs to be faxed after sending the referral in Resource Matching and e-Referral (RM&R)

Form #PSR003 – Humber River Hospital
Please Note: This form needs to be faxed after sending the referral in Resource Matching and e-Referral (RM&R)

Form #PSR003 – Humber River Hospital
Please Note: This form needs to be faxed after sending the referral in Resource Matching and e-Referral (RM&R)

Form #PSR003 – Humber River Hospital
Please Note: This form needs to be faxed after sending the referral in Resource Matching and e-Referral (RM&R)

Please Note: This form needs to be faxed after sending the referral in Resource Matching and e-Referral (RM&R)

For Southlake only
Please Note: This form needs to be faxed after sending the referral in Resource Matching and e-Referral (RM&R)
Signed Physician Medical Orders are not required for Occupational Therapy, Personal Support and Physiotherapy

A School Board Consultant’s report and signature are required from school boards that have Occupational Therapy/Physiotherapy/Speech Language Pathology consultants.
Phone: 416-222-2241 or 905-895-1240 or 1-888-470-2222
Fax: 416-222-6517 or 905-952-2404
*Incomplete referrals will NOT be processed

School Health Support Services (SHSS) is a program of Ontario Health atHome which assists children with rehabilitation needs and/or physical challenges to attend school and participate in school-related activities. Services are funded by the Ministry of Health and Long Term Care; therefore, the student must have a valid Ontario Health Insurance Number in order to receive Ontario Health atHome services.

For Health System Partners
Updated June 17, 2026

Important Update: Discharge & Transitions Support
When informing patients about home and community care services, it is important to advise that all mobile, eligible patients will receive nursing care in our community nursing clinics.

Prepared in accordance with section 14 of the Broader Public Sector Accountability Act, 2010 (“BPSAA”)

Prepared in accordance with section 14 of the Broader Public Sector Accountability Act, 2010 (“BPSAA”)

Prepared in accordance with section 14 of the Broader Public Sector Accountability Act, 2010 (“BPSAA”)

Prepared in accordance with section 14 of the Broader Public Sector Accountability Act, 2010 (“BPSAA”)

Prepared in accordance with section 14 of the Broader Public Sector Accountability Act, 2010 (“BPSAA”)

Prepared in accordance with section 14 of the Broader Public Sector Accountability Act, 2010 (“BPSAA”)

Prepared in accordance with section 14 of the Broader Public Sector Accountability Act, 2010 (“BPSAA”)

Office Location: North East
Tel: 1-800-461-2919 / Toll FreeFax: 1-855-697-7358
*Hospital: Use hospital Ontario Health atHome fax number

This form is to be used for the submission of requests for additions, changes, or considerations related to the Ontario Health atHome Medical Equipment and Supplies (MES) Formulary. Submissions may include requests for new products, product substitutions, or other formulary updates. Information collected through this form supports standardized review and decision-making based on clinical evidence, patient need, supply chain resilience and fiscal responsibility. Completed forms must be submitted to the MESModernization@ontariohealthathome.ca for review.

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

Please fax referral form(s) to: 613-650-2909
For inquiries, contact Ontario Health atHome: 1-833-515-1234 ext. 6244

Primary Care Provider Information about remote monitoring and intensive health coaching program for COPD & Heart Failure
Telehomecare (THC) is a six (6) month program that links patients who have COPD or heart failure with Registered Nurses who provide remote monitoring and regular health coaching. Patients become partners in their own care – right in their own homes.
Telehomecare complements the care you already provide for your COPD or heart failure patients.

Telehomecare (THC) is a six (6) month program that enables patients to become partners in their own care, right in their own homes using technology as the enabler.
The program is provided by THC nurses to help people living with conditions such as heart failure and chronic obstructive pulmonary disease (COPD) achieve the best possible quality of life while learning to manage their condition through remote monitoring and regular health coaching sessions in their own homes.

Ontario Health atHome Posting of Travel, Meal and Hospitality.
Executive Expense Report for Designated Individuals for Quarter 4 – Fiscal Year 2025-26

Ontario Health atHome Posting of Travel, Meal and Hospitality Board of Directors Expense for Quarter 4 – Fiscal Year 2025/26

Investing in our People, Strengthening Partnerships, Transforming Care
At Ontario Health atHome, our people are fundamental to achieving our mission to help everyone to be healthier at home through integrated and equitable care in partnership with the communities we serve.

Monday – Friday 08:30 – 16:30
Campbellford Memorial Hospital Fax: 844-631-5800
Haliburton Highlands Health Services Fax: 844-709-3779
Northumberland Hills Hospital Fax: 844-631-5801
Lakeridge Health Bowmanville Fax: 844-631-5802
Lakeridge Health Oshawa Fax: 905-444-2516
Lakeridge Health Port Perry Fax: 844-631-5803
Markham Stouffville Uxbridge Fax: 844-631-5803
Ontario Shores Fax: 844-631-5803
Peterborough Regional Health Centre Fax: 855-444-9628
Scarborough Health Network The Scarborough Hospital – Birchmount Site Fax: 844-631-5804
Scarborough Health Network – General Campus Fax: 844-631-5805
Ross Memorial Hospital Fax: 844-631-5806
Scarborough Health Network – Centenary Site Fax: 844-631-5808
Lakeridge Health – Ajax/Pickering Fax: 905-444-2524
Whitby Hospital Fax: 905-665-2405

Fax completed form to: 905-855-8989 / 1-877-298-8989

On National Caregiver Day and beyond, Ontario Health atHome is grateful to the thousands of caregivers whose efforts make it possible for others to live safely at home, wherever that may be.
We are honoured to celebrate these outstanding individuals and to share stories that highlight both the unique and universal experiences of caring.

Tips on how to join the 2026 event using Teams.

2026 Event Agenda

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.

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

April 2026

You and/or your caregiver may choose to communicate with your care coordinator or service provider by email, text or other platforms (e.g., Gmail, Outlook, DocuSign).
Electronic communication is meant to support, not replace, phone or in-person conversations, and because of privacy and cyber security risks, Ontario Health atHome requires your consent before using electronic communication for purposes of your care.

Need Mental Health and Addictions Support?

Our specialized nurses work in the community and in schools to assist

• students with various mental health and addictions challenges.
• Assess and monitor mental health and addictions concerns
• Connect students with services within the community
• Collaborate with schools, families and care partners, to support a
  student’s care plan, goals and treatments
• Medication assessment, support and education
• Support transitions back to school from hospitals or other care settings

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.

A guide for patients and families and caregivers
Getting ready to move into a long-term care home can be a challenging time. Knowing this, we are committed to making the process as easy as possible for you and your family/caregivers. Based on your most recent assessment, your care coordinator has determined that you will be prioritized as category 1 (crisis) on the waiting list for all long-term care homes that you select. This category is for people who need immediate admission to long-term care and cannot have their needs met at home.

Bukaan ahaan, xubin qoyska ka tirsan, wakiil qof kale ama daryeele ahaan, waxaad xaq u leedahay inaad fishoo in shaqaale kasta oo ka tirsan Ontario Health atHome, xubin ka tirsan Guddiga iyo bixiye adeeg caafimaad oo qandaraas la galay uu ixtiraamo oo uu kor ugu qaado xuquuqdaada sida soo socota:

Ontario Health atHome Posting of Travel, Meal and Hospitality Board of Directors Expense for Quarter 3 – Fiscal Year 2025/26

Ontario Health atHome Posting of Travel, Meal and Hospitality.
Executive Expense Report for Designated Individuals for Quarter 3 – Fiscal Year 2025-26

Within this report is Ontario Health atHome’s Annual Report for 2024/25 (Q2-Q4 June 28, 2024 to March 31, 2025). Our report begins on page 86.

*Requests are only for Hospital to Home (H2H) patients already being supported by H2H program within the community
**Hospital based patients are to be initiated as per hospital Ontario Health atHome processes
Please fax completed form to Ontario Health atHome H2H ODB team at 1-877-546-4311

Confirmation of medical stability and program readiness
Inpatient rehabilitative care and other complex continuing care
Do NOT use this application for Palliative care referrals.

Prequalification Status Expires December 31, 2027
Service providers identified below have prequalified to bid on Ontario procurements for selected home care services.
Note: Prequalification levels are confidential to Ontario Health atHome, Ontario Health and the individual service providers.

Designated Public Sector Accessibility Compliance Report
Section 15 of the Accessibility for Ontarians with Disabilities Act, 2005 (AODA) requires that accessibility reports include a statement certifying that all the required information has been provided and is accurate, signed by a person with authority to bind the organization(s).

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) .

Approval Date: December 2025
Updates: 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: 1-888-470-2222
TTY: 711

December 2025
As an agency in its first full year, Ontario Health atHome has made significant advancements towards harmonizing our approach to reducing and removing barriers while also improving access to services in an inclusive employment environment.
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: 1-833-515-1234
TTY: 711

Ontario Health atHome policies are an important part of developing an organizational culture that connects and inspires all team members across the province.
This policy sets out Ontario Health atHome’s commitment to accessibility in accordance with the Accessibility for Ontarians with Disabilities Act, 2005 (“AODA”) (opens in a new tab) and Ontario Regulation 191/11: Integrated Accessibility Standards (“IASR”) (opens in a new tab) , under the AODA. This policy should be read in conjunction with Ontario Health atHome’s AODA Multi-Year Accessibility Plan (“MYAP”).

Effective Date: October 28, 2026
Note: Manufacturer Backorder and Discontinuation lists are reviewed and validated on a weekly basis and will be updated if there are changes to the list.

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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.

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.

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.
All Community Referrals, Including Primary Care Providers: Please fax all community referrals to Intake and Extended Hours teams
Fax Number for All
1-866-655-6402
For hospital-based referrals, please fax directly to the appropriate Ontario Health atHome hospital officeFor hospital-based referrals, please fax directly to the appropriate Ontario Health atHome hospital office

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.

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.
All Community Referrals, Including Primary Care Providers:
Please fax all community referrals to Intake and Extended Hours teams
Fax Number for All 1-866-655-6402
For hospital-based referrals, please fax directly to the appropriate Ontario Health atHome hospital office

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.

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.

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.

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.

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.

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

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

Pediatric Patients at McMaster Children’s Hospital (MCH) Hamilton
Toll Free Phone Number: 1-800-810-0000
All Community Referrals, Including Primary Care Providers: please fax all community referrals to Intake and Extended Hours teams. Fax Number for All:
1-866-655-6402
For hospital-based referrals, please fax directly to the appropriate Ontario Health atHome hospital office listed in page 2 of this form

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

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

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

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:

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.

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

Form 550 B – Fax Completed form to 519-742-0635

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.

Info for Service Providers

Info for Services Providers

Fax: 1-855-697-7358

*Hospital: Use hospital Ontario Health atHome fax number

Effective September 1, 2026
Fax: 1-855-697-7358

*Hospital: Use hospital Ontario Health atHome fax number

Effective September 2026
Fax: 1-855-697-7358 /Print to NE-Regional E&S
*Hospital: Use hospital Ontario Health atHome fax number

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

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.

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 atHome
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.

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.

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).

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。

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.

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

Last Update: May 2026
Fax: 1-855-697-7358

*Hospital: Use hospital Ontario Health atHome fax number

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

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 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.

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.

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

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

Medigas Medical Equipment Catalogue for the following areas: North East and North West
Updated: August 2026

Medigas Medical Equipment Catalogue for the following areas: Central, Central West, Mississauga Halton, North Simcoe Muskoka, and Toronto Central
August 2026

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.

Effective August 18, 2026
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.

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

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 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.

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.

Effective September 22, 2026
This document provides a list of infusion and supply kit contents categorized by kit name and component items within each kit.

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.

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.

Parenteral Nutrition Order (Adult or Pediatric)
Complete and fax to Ontario Health atHome at 1-519-472-4045 or 1-855-223-2847
Orders are processed between 8:00 am – 8:00 pm (7days/week). Please allow 48 hours for orders to be processed. Referral form must be completed in full to permit processing. Incomplete orders will be returned.

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

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

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

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 patient et des soins de santé.

Last update: October 2026

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

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

*Hospital: Use hospital Ontario Health atHome fax number

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.

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

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 Hamilton Niagara Haldimand Brant 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

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

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

Statement of financial position for Waterloo Wellington as at June 27, 2024

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

Fax: 1-844-858-3546/ Toll Free

*Hospital: Use hospital Ontario Health atHome fax number

Fax: 1-844-858-3546/ Toll Free

*Hospital: Use hospital Ontario Health atHome fax number

Fax: 1-844-858-3546/ Toll Free

*Hospital: Use hospital Ontario Health atHome fax number

Fax: 1-844-858-3546/ Toll Free

*Hospital: Use hospital Ontario Health atHome fax number

Fax: 1-844-858-3546/ Toll Free

*Hospital: Use hospital Ontario Health atHome fax number

Wound Care and General Supply Order Form for Central West area

Urinary Continence Supply Order Form for Central West area

Respiratory Therapy Supply Order Form for Central West area

Ostomy Supply Order Form for Central West area

Infusion and Enteral Supplies Order Form for Central West area

Effective October 14, 2026
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 22, 2026
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.

Incomplete referrals will be returned to the referral source with direction for completion
For urgent admissions to Parkwood Palliative Care Unit (PCU), please fax to 519-685-4804 and to the appropriate Ontario Health atHome number noted above.

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

To refer a patient to (apply for) hospice and hospice-type services at: Emmanuel House, Carpenter House, Hospice Niagara McNally House, Dr. Bob Kemp Stedman Margaret’s Place

Useful Links for Caregivers and Families
The following resources are available to help you learn more about home and community care services and palliative care.

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.

Need Mental Health and Addictions Support?
WE’RE HERE TO HELP … Mental Health and Addictions Nurses are available throughout the week to support you.

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.

Statement of financial position for Waterloo Wellington as at March 31, 2024

Statement of financial position for Toronto Central as at March 31, 2024

Statement of financial position for South West as at March 31, 2024

Statement of financial position for South East as at March 31, 2024

Statement of financial position for North West as at March 31, 2024

Statement of financial position for North Simcoe Muskoka as at March 31, 2024

Statement of financial position for North East as at March 31, 2024

Statement of financial position for Mississauga Halton as at March 31, 2024

Statement of financial position for Hamilton Niagara Haldimand Brant as at March 31, 2024

Statement of financial position for Erie St. Clair as at March 31, 2024

Statement of financial position for Central West as at March 31, 2024

Statement of financial position for Champlain as at March 31, 2024

Statement of financial position for Central area as at March 31, 2024

Statement of financial position for Central East as at March 31, 2024

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

Le quatrième plan d’activités annuel donne suite aux efforts réalisés depuis notre création en juillet 2021, mettant en valeur la transition vers un organisme et un rôle
nouveaux dans le système de soins de santé.

Our fourth Annual Business Plan, since our inception in July of 2021, builds on our accomplishments to date, while also focusing on our future transition into a new organization and role within the health care system.

Home and Community Care Support Services Board of Directors Expense Report for Q1 2024/25 Fiscal Year

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

Need a family doctor or nurse practitioner?
Your new family health care provider might be just a phone call away. Our team of Care Coordinators identifies doctors and nurse practitioners in your community who are accepting patients and links them with people who are looking for a health care provider.

What is the Convalescent Care Program?
Following surgery or serious illness, you may no longer need in-hospital care but you may not be ready to return home safely.
The Convalescent Care Program provides 24-hour care to people who require specific medical and therapeutic services in a supportive environment. The program will help you recover your strength, energy and functioning before returning home.

Need Mental Health and Addictions Support?
WE’RE HERE TO HELP … Mental Health and Addictions Nurses are available throughout the week to support you.

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.

Helping students thrive, cope and succeed:
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.

Need Mental Health and Addictions Support?
We’re here to help: Mental Health and Addictions Nurses are available throughout the week to support you.

Effective August 18, 2026
This document provides a formulary listing of Negative Pressure Wound Therapy equipment and 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.

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.

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

*Hospital: Use hospital Ontario Health atHome fax number

Chatham-Kent Health Alliance inpatient referral and treatment form – fillable

Windsor Regional Hospital – Met Campus inpatient referral and treatment form – fillable

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.

Hôtel-Dieu Grace Healthcare inpatient referral and treatment form – fillable

Erie Shores HealthCare inpatient referral and treatment form – fillable

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 revised form will be effective as of September 2026.

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. 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.

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.

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.

Erie Shores HealthCare outpatient referral and treatment form – fillable

Windsor Regional Hospital – Ouellette Campus emergency referral and treatment form – fillable

Windsor Regional Hospital – Met Campus outpatient referral and treatment form – fillable

Windsor Regional Hospital – Ouellette Campus outpatient referral and treatment form – fillable

Windsor Regional Hospital – Met Campus emergency referral and treatment form – fillable

The Hamilton Palliative Care Outreach Team (PCOT) is a group of specialist providers from multiple organizations who practice as an interprofessional team.
Eligibility Criteria:
Patients, along with their families/caregivers, are eligible for the Palliative Care Outreach Team services if they meet most of the following criteria:
• Live in the Greater Hamilton area
• Diagnosed with a life-limiting progressive disease
• Complex symptoms
• Meets the Gold Standard Framework “surprise” question:
o Would you be surprised if this person were to die within the next 12 months?
o Are there general signs of decline?
• Complex needs (e.g., social determinants of health)
• Challenges with goals of care discussions/care planning
• Declining functional status
• Complex or potentially complex psychosocial/spiritual needs for the patient and/or family/caregiver

Symptom Response Kit (SRK) Request Order Form Windsor

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

Cupboard Usage (Provider and Flex Clinics)
Please Submit This Order Through HPG To Supplies Chatham: 519-351-7080 Ext. 7400

Best practice/evidenced based practice will be initiated unless otherwise written. Wound care outside of evidenced based practice may not be eligible for Ontario Health atHome services. Treatment will be taught and service reduced when appropriate.

Medical update request form – wound

Physician use only. Applicable billing as outlined in the Schedule of Benefits for Physician Services under the Health Insurance Act.

Erie Shores HealthCare emergency referral and treatment form – fillable

Offloading assessment form – fillable

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

Electrical Stimulation (eSTIM) referral assessment form – fillable

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