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SMILE PROGRAM

Bill Ryan...VON SMILE Program Referral Form...SMILE Fax (for referrals & assessments only): 1-833-255-5672...Created: 2008...Updated: April 2023...Version 8...Next Review: 2025...Client Information...Age...
https://www.southeasthealthline.ca/pdfs/SMILE%20Referral%20Form%20-%20Ver.8.pdf

Client Onboarding Document

support for all those living with or affected by a life-limiting illness....WIFI NETWORK: Hospice Guest Residence*PASSWORD:...HOSPICE PRINCE EDWARD...W W W . H O S P I C E P R I N C E E D W A R...
https://www.southeasthealthline.ca/pdfs/Hospice%20Guide.pdf

kingston-youth-transitions-application

... goals?...Housing Information...Where are you currently living and with whom:...Why do you want/need to leave there?...Where did you live before this? ...(if applicable)...Signature Date
https://www.southeasthealthline.ca/pdfs/kingston-youth-transitions-application.pdf

vh_resident_rights_responsibilites_jan2018.pdf

 to be consulted on, and to choose to have input into, decisions about the living...arrangements of Victoria House; to have access to information about his or her rights, care,...accommodation...
https://www.southeasthealthline.ca/pdfs/vh_resident_rights_responsibilites_jan2018.pdf

VON_Stroke_Services_brochure_June 2021.pdf

member/friend living in the community or...long-term care/retirement home....· Focus is on reducing caregiver strain...through self-care, knowledge of community...resources and information about...
https://www.southeasthealthline.ca/pdfs/VON_Stroke_Services_brochure_June%202021.pdf

New Client Application Form - Sept 2023 -FINAL.pdf

Living with Mental Health and/or Substance Use...trans/transitioning/contemplative...BQWCHC PHC-100 New Client Application Form NEW: Sept 2023...Social Support – Check any that apply to you...If I...
https://www.southeasthealthline.ca/pdfs/New%20Client%20Application%20Form%20-%20Sept%202023%20-FINAL.pdf

CCSH Community Stroke Groups - Hastings Prince Edward June 2018.pdf

Language Pathologist - meet other adults living with Aphasia, and practice your...communication skills in a fun, stimulating environment. ...Sessions are 1.5 hours each...week for 8 weeks. ...For...
https://www.southeasthealthline.ca/pdfs/CCSH%20Community%20Stroke%20Groups%20-%20Hastings%20Prince%20Edward%20June%202018.pdf

as_first_link_referral_form.pdf

...d...Living Arrangement/...Transition Support...Information/Education...Safety Concerns...Finding Community Supports...Staying Socially/Physically Engaged...Emotional Support...Changes in Behaviour
https://www.southeasthealthline.ca/pdfs/as_first_link_referral_form.pdf

lanark_county_community_paramedic_program_clinical_guidelines.pdf

Contribute to the overall quality of life for people living at home, retirement and/or congregate...settings....2. ...Provide education to clients regarding their health....3. ...Help bridge...
https://www.southeasthealthline.ca/pdfs/lanark_county_community_paramedic_program_clinical_guidelines.pdf

Centralized Referral Form

Do you live/Will you be living alone?...Yes No...Will you require support services?...Yes No Unsure...Are you currently employed:...Yes No...Source of Income: ODSP CPP EI OW...Unknown...Are...
https://www.southeasthealthline.ca/pdfs/SCIO-centralized-referral-form.pdf