Waterloo Wellington

Information sheet for patients about Community Nursing Clinics located in Waterloo Wellington

Information sheet for patients about Community Nursing Clinics located in Waterloo Wellington ( French)

Completed by a Coordinated Bed Access Coordinator (HCCSS staff) for transfers in the rehab bed program

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.

Completed by a Primary Care Physician

Fax cover sheet that can be used to accompany MAID referral document

Completed by a Primary Care Physician

To order care relating to parenteral therapy

Mental Health and Addictions Nursing Program Referral Form – Completed by a School Social Worker (SW) or Child/Youth Worker (CYW), Primary Care Physician, Psychiatrist, CAIP (GRH staff in the inpatient mental health program)

Can be completed by a Primary Care Physician, Nurse Practitioner, NSWOC(Nurse specializing in wound, ostomy and continence care), or CNS (clinical Nurse specialist)

Completed by a community or hospital care coordinator (HCCSS staff) along with the patient/family for EOL(end of life) care

Completed by a Primary Care Physician or Registered Dietician

Completed by Retirement Home(RH) or HCCSS staff to outline services that a patient is currently receiving or may require if moving to a Retirement Home setting

Completed by Retirement Home staff when requesting a Swallowing Assessment

Application for HCCSS staff to be completed for a patient moving from Acute Care to a Rehab bed in the WW region.