Hamilton Niagara Haldimand Brant

Renseignements concernant les patients et renvois

310-2222

(sans indicatif régional)

Toll-free:1 800 810-0000
Télécopieur : 1 866 655-6402 (for patient-related information and referrals)
TTY :711
Par courriel :access@hccontario.ca

Veuillez NE PAS transmettre des renseignements personnels sur la santé. Ce courriel ne doit pas servir à traiter des renvois ni à recevoir les commentaires des patients. Veuillez nous appeler aux numéros indiqués ci-dessus. Nous répondons généralement dans un délai de 72 heures. Toutefois, veuillez noter que ce compte n’est pas vérifié les fins de semaine ni les jours fériés.

Visitez le site Web lignesanté Hamilton Niagara Haldimand Brant

Emplacements des bureaux de Hamilton Niagara Haldimand Brant

  • Hamilton (Corporate Office)
    211, chemin Prichard,
    Unité 1,
    Hamilton, ON, L8J 0G5
  • Niagara
    149, chemin Hartzel,
    St. Catharines, ON, L2P 1N6
  • Haldimand-Norfolk / Brant
    195, rue Henri,
    Unité 4, Bâtiment 4,
    Brantford, ON, N3S 5C9
  • Burlington
    440, rue Élizabeth,
    4ème étage,
    Burlington, ON, L7R 2M1

Compliments et Inquiétudes

Veuillez transmettre vos commentaires à votre coordonnateur de soins. Vous pouvez aussi communiquer vos compliments ou préoccupations d’une des manières suivantes :

Par courriel : hnhb.patientrelations@hccontario.ca

Téléphone : 1 866 790-4642 poste 3883

Par poste : Attention – Gestionnaire des relations avec les patients
211, chemin Pritchard, unité 1, Hamilton, ON L8J 0G5

Salle de nouvelles et relations avec les médias

Visitez notre salle de nouvelles pour en savoir plus sur les actualités et événements.

Pour toute demande de renseignements des médias, veuillez envoyer un courriel à l’adresse HCCSSmedia@hccontario.ca.

Pour les demandes ne provenant pas des médias concernant Services de soutien à domicile et en milieu communautaire, et pour mieux vous servir, veuillez visiter la page Pour nous joindre pour obtenir des coordonnées supplémentaires.

Formes

TitleSummaryRegionLast ModifiedCategoryFile TypeFile SizeLinkhf:doc_tagshf:doc_categorieshf:file_type
Brant (use the Hospice Referral Form and order Outreach Services)

Please use the Hospice Referral Form to request the palliative care outreach services in Brant.

December 8, 2022pdf2 MBhamilton-niagara-haldimand-brantformspdf
Burlington PCOT Referral Form

To request the services of the Palliative Care Outreach Team in Burlington

November 8, 2023pdf1 MBhamilton-niagara-haldimand-brantformspdf
Ceftriaxone Protocol Medical Referral Form

To order the administration of ceftriaxone to patients being discharged from the Brantford Community Healthcare System (BCHS)

September 20, 2022pdf1 MBhamilton-niagara-haldimand-brantformspdf
Enhanced Pain Management Registration Form

Registration Form – Essential Pain Management Winter 2024 session

May 9, 2024pdf2 MBhamilton-niagara-haldimand-brantformspdf
First Dose – IV Medications Form

To order first dose IV medications to be administered to patients in the community. First dose requests may take longer to process and are not appropriate for urgent requirements.

April 12, 2024pdf677 KBhamilton-niagara-haldimand-brantformspdf
Fundamentals Registration Form FR

Registration form in French – spring 2023

May 9, 2024pdf511 KBhamilton-niagara-haldimand-brantformspdf
Haldimand Norfolk PCOT Referral Form

To request the services of the Palliative Care Outreach Teams in Haldimand Norfolk

December 9, 2022pdf1 MBhamilton-niagara-haldimand-brantformspdf
Hamilton PCOT Referral Form

To request the services of the Palliative Care Outreach Team in Hamilton

November 8, 2023pdf2 MBhamilton-niagara-haldimand-brantformspdf
HNHB Community Paramedicine Communication Form

Paramedic Services will communicate back to Home and Community Care Support Services using the HNHB Community Paramedicine Communication Form.

March 23, 2023pdf3 MBhamilton-niagara-haldimand-brantformspdf
HNHB Medical Supplies Catalogue

To order from HNHB’s medical supplies catalogue

October 18, 2022pdf708 KBhamilton-niagara-haldimand-brantformspdf
HNHB Referral Form – EN

Complete the Request for Home and Community Care Support Services HNHB form 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.

March 6, 2023pdf1 MBhamilton-niagara-haldimand-brantformspdf
Home Parenteral Nutrition Medical Order Form – Pediatric at McMaster Children’s Hospital

To order care relating to the Protocol for Home Parenteral Nutrition (PPN or TPN) for pediatric patients at McMaster Children’s Hospital

October 5, 2022pdf2 MBhamilton-niagara-haldimand-brantformspdf
Hospice Referral Form

To refer a patient to (apply for) hospice and hospice-type services

September 20, 2022pdf2 MBhamilton-niagara-haldimand-brantformspdf
HPG User Access Authorization Form

For hospital partners who use Health Partner Gateway to receive patient referrals.

September 20, 2022pdf1 MBhamilton-niagara-haldimand-brantformspdf
Influenza Vaccine Form

To order administration of influenza vaccine

December 19, 2023pdf344 KBhamilton-niagara-haldimand-brantformspdf
Iron Infusion Order Form

Hamilton Niagara Haldimand Brant, Iron Infusion order form – To order intravenous iron replacement

December 13, 2023pdf2 MBhamilton-niagara-haldimand-brantformspdf
Letter of Understanding – Pronouncement and Certification Death

To identify who will complete pronouncement and certification of death for an expected death at home

September 20, 2022pdf1 MBhamilton-niagara-haldimand-brantformspdf
Long-Term Care Home Referral for Service

For Long-Term Care Partners in HNHB. Please complete and fax the Long-Term Care Home Referral for Service form to request one or more of the following services for residents:
• Nursing
• Wound Care
• Speech Language Pathology for Swallowing Assessment

August 14, 2023pdf2 MBhamilton-niagara-haldimand-brantformspdf
Margaret’s Place Palliative Overnight Respite Referral Form

To be completed and signed by an HCCSS Care Coordinator to refer a patient to Margaret’s Place for Palliative Overnight Respite care

July 25, 2023pdf1 MBhamilton-niagara-haldimand-brantformspdf
Medical Order Form – General

To order general medications, including wound care and maintenance for urinary catheters

April 23, 2024pdf650 KBhamilton-niagara-haldimand-brantformspdf
Medical Supplies Catalogue

To order from HNHB’s medical supplies catalogue

December 8, 2022pdf708 KBhamilton-niagara-haldimand-brantformspdf
MHAN Referral Form

Mental Health and Addictions Nursing Program Referral Form.

To request the services of the Mental Health & Additions Nurse, the patient must be:

1. A student registered in school and who is no older than 21 years of age (may include home instruction)
2. In need of services or related treatment to an identified and/or suspected mental health and/or addictions issue
3. Aware of and consenting to the referral

Additionally, there must be a clearly defined role for the Mental Health & Addictions Nurse

May 31, 2023pdf1 MBhamilton-niagara-haldimand-brantformspdf
Midline Catheter Form

To order midline catheter maintenance

September 20, 2022pdf2 MBhamilton-niagara-haldimand-brantformspdf
Milrinone Home Infusion Order Form for Adult Patients

To order Milrinone Infusion Therapy for adult patients

May 4, 2023pdf731 KBhamilton-niagara-haldimand-brantformspdf
Negative Pressure Wound Therapy Form

To request negative pressure wound therapy for pressure ulcers, diabetic foot ulcers, arterial ulcers, venous ulcers and surgical wounds

September 20, 2022pdf2 MBhamilton-niagara-haldimand-brantformspdf
Negative Pressure Wound Therapy Special Circumstance Form

To request negative pressure wound therapy for patients with special circumstances, e.g. patient has had a wide excision with skin graft or an STSG greater than 2 cm squared

September 20, 2022pdf1 MBhamilton-niagara-haldimand-brantformspdf
Niagara PCOT Referral Form

To request the services of the Palliative Care Outreach Team in Niagara.

December 8, 2022pdf2 MBhamilton-niagara-haldimand-brantformspdf
Nursing Care Centre – Information Handout HNHB

Nursing Care Centre locations throughout HNHB geography.

December 8, 2022pdf490 KBhamilton-niagara-haldimand-brantformspdf
Palliative Symptom Response Form

For the management of rapid-onset, unanticipated symptoms for patients nearing end–of-life and no longer able to swallow oral medications. The medication on this order form is limited to support short duration of symptom management (48 hours) until further medications are ordered. Note: See Palliative Care Symptom Response Guidelines for more info on how to use the form.

December 8, 2022pdf993 KBhamilton-niagara-haldimand-brantformspdf
Palliative Symptom Response Guideline

Guidelines how to use the Palliative Symptom Response Order Form.

December 8, 2022pdf3 MBhamilton-niagara-haldimand-brantformspdf
Patient and Family Information about Palliative Symptom Response Medication

Information sheet for patients and families.

December 9, 2022, pdf334 KBhamilton-niagara-haldimand-brantforms information-sheetpdf
Pediatric Milrinone Infusion Therapy

To order Milrinone Infusion Therapy for pediatric patients

May 3, 2023pdf407 KBhamilton-niagara-haldimand-brantformspdf
Plan of CPR Treatment Form – Palliative Care

To clearly communicate a patient’s plan of care relating to the provision of CPR.

September 20, 2022pdf733 KBhamilton-niagara-haldimand-brantformspdf
Protocol for Central Vascular Access Devices – Pediatrics

To order care relating to vascular access devices in children

September 20, 2022pdf2 MBhamilton-niagara-haldimand-brantformspdf
Protocol for Vascular Access Devices Medical Order Form

To order care relating to vascular access devices in adults (in accordance with the Vascular Access Maintenance Protocol)

September 20, 2022pdf1,014 KBhamilton-niagara-haldimand-brantformspdf
Protocol Parenteral Nutrition Medical Order Form- Adult Population

To order care relating to the Protocol for Home Parenteral Nutrition (PPN or TPN) for adult patients

September 20, 2022pdf1 MBhamilton-niagara-haldimand-brantformspdf
Respiratory Therapy Referral Form

For patients being discharged home from hospital with a new tracheostomy and laryngectomy care for patients being discharged home from hospital

December 8, 2022pdf1 MBhamilton-niagara-haldimand-brantformspdf
Vancomycin Aminoglycoside Prescription Form

To order IV vancomycin and/or aminoglycosides for patients in the community

September 20, 2022pdf812 KBhamilton-niagara-haldimand-brantformspdf