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Primary Care Practitioner

If you are a primary care practitioner or work in a physician's office, the following information will make it easier for you to work with us.

Primary Care Practitioner Priority Phone Line

Call 613-310-2222 and press '2' to access this physicians-only line. An Information & Referral Specialist will take your call every day from 8 am to 8 pm.  

Making a Referral

If you have a patient with an acute or chronic care need that is not met with current treatment and supports, we can provide a variety of services to facilitate care in the home and the community. We also assess and determine eligibility for long-term care and respite care.

To make a referral to us, download our referral form. For Long-Term care referrals, complete both the referral form AND a Ministry of Health and Long-Term Care Health Assessment Form 4768-69E (2015/01). These Health Assessment forms were introduced by the Ministry in 2015 and are also available on their website directly.

View our Primary Care Resource Sheet for Home and Community Care Supports for billing codes and additional details about our services.`


making a referral for palliative care 

  1. Champlain Hospice Palliative Symptom Management Kit

    A Champlain Hospice Palliative Symptom Management Kit (SMK) is available for palliative care clients who require access to medications and supplies needed in urgent palliative care situations in the home. The SMK includes enough medications and related medical supplies to manage the palliative client's distressing symptoms in the home for a 24 to 72 hour period.

    For Physicians requesting Palliative Symptom Management, please download the Champlain Palliative Symptom Management Kit – Medication Order Form

    For more information about the Champlain Palliative Symptom Management Kit (SMK), please call (613) 310-2222.

  2. Symptom Management Referrals for Infusion Therapy

    Physicians who order medications that are administered for pain and symptom management by infusion route are encouraged to complete the Medical Referral Infusions for Symptom Management that provides an efficient, comprehensive method of ordering and obtaining this specialized care for patients. 

  3. ​​The Regional Palliative Consultation Team


The Regional Palliative Consultation Team connects, supports and cares for patients who have a life-limiting illness in the Champlain region. Our nurses help people and families understand their options and provide support.​ Learn more​.

Referrals for home-based palliative care can be made through us

Download an RPCT Referral Form and view a brochure.​



Information for Physicians and Nurse Practitioners 

The following information outlines our role in Medical Assistance in Dying, available services, requirements, and timelines, in order to be able to arrange services for patients who are requesting Medical Assistance in Dying at home. 

See also: 

List of forms

Referral formGeneral referral form for primary care to request community services
Primary Care Resource Sheet General information for primary care including billing codes
Ministry of Health and Long-Term Care Health Assessment Form 4768-69E (2015/01)Ministry of HLTC required document for LTC applications
The Champlain Palliative Symptom Management Kit - Medication Order Form (SMK) Easy-to-use order guide and form for prescribing symptom management medications and supplies in the community
Medical Referral Infusions for Symptom ManagementForm to order medications via CADD Solis pump
RPCT Referral FormRegional Palliative Consultation Care Team referral form for consultation in palliative pain and symptom management and complex end-of-life care
Aminoglycoside Screening AlgorithmWhen to order bloodwork in the community
CCIQC First Dose Parenteral Medication Administration GuidelineA guide to determine if the first dose of a drug can be safely administered in the community
Community IV Therapy Venous Access AlgorithmA guide to assist with the decision of peripheral versus central venous access device (CVAD) catheters
Champlain LHIN IV Acess Care 
Used to order IV therapy
Champlain LHIN Medical Referral
Medical referral form usually used by hospital and outpatient clinics to request home care services features current and reliable information about more than 3000 health and community services in the region. Search for services by keyword, postal code, category or alphabetical.

Consult the list of Primary Care Desktop Resource Guides to quickly access phone numbers and websites related to a number of health and community services.


Health Care Connect

We are a key partner in Health Care Connect, a program that connects patients with primary care providers. Our Care Connectors can link you to unattached patients. Learn more »


Working hand-in-hand with Primary Care



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