Hospitals and Primary Care

​​We look for every opportunity to partner with family physicians, nurse practitioners and our hospitals. 

We can help your patients live safely and comfortably at home, and make the transition from hospital to home or from home to other living arrangements.

Making a referral is simple.

To make a referral, complete the Home and Community Care referral form ​and fax it to the appropriate office.

• London/Middlesex Elgin: 519-472-4045
• Grey/Bruce/Perth/Huron/Oxford: 519-273-2847 or 1-855-223-2847

You can also make a referral by:

• connecting with your Care Coordinator on site (if you have one)
• calling us at 310-2222 (no area code necessary)

Resources and other forms

Diabetes Type 1 Request Treatment

• Diabetes Type 1 Request Treatment Form

Enteral Feed 

• Enteral Feed Order Form 

• ​Enteral Feed Patient Guide 

Home Hemodialysis Patient IV Referrals

• Hemodialysis IV Referral Form

Hydration Order Form

• Hydration Order Form

IV Antibiotic Referral Order Form

•  IV Antibiotic Referral Form
• IV Elastomeric Patient Instructions
•  IV Patient Information Handout
•  IV First Dose and Iron Sucrose Screener_SW LHIN
• *NEW - Adult Standard Flush Protocol - South West LHIN

Long Term Care

• LTCH Health Assessment

Medical assistance in dying

• Medical assistance in dying process information 
• Referral form​

Negative Pressure Wound Therapy (NPWT) Referral Information Sheet

• Negative Pressure Wound Therapy Referral 

Pain and Symptom Management Form

• Pain and Symptom Management Form

Palliative Care

• Communication Protocol - Complex Palliative Care
• Palliative patient status update form

Physician Notification of Concern/Compliment

• Notification of concern or compliment 

Symptom Response Kit  

• ​Symptom Response Kit (SRK) Prescription Form ​
• Symptom Response Kit (SRK) Guideline

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Exceptional Access to Palliative Medications

This is a reminder to providers that they CAN obtain exceptional access to palliative medications for their patients at end of life.

The family doctor does not have to be a designated palliative care physician in order to have certain palliative medications covered at the end of life. The process is just a phone call approval is typically granted immediately. The process is outlined below.

Call 1-866-811-9893 (nurse can make the call)

• CPSO number
• Patient's OHIP number
• Medication/formulation requested
• Indication
• Diagnosis & prognosis (<6 months)

**Approval decision provided immediately over the phone

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