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CHEO - Social Work Services

Let us know about changes to your services. ... Add to clipboard...  Print...Program :...Social Work Services  ...Organization :...CHEO...Phone Numbers :...Social Work Office 613-737-7600 ext 2360...CHEO...
https://www.southeasthealthline.ca/displayService.aspx?id=211253 Voir en français

400971-RMandR-Rehabilitation-Referral-Form-2017-03.pdf

 At the time of discharge from acute care, acute medical issues have been addressed: disease processes...and/or impairments are not precluding participation in rehabilitation program.......
https://www.southeasthealthline.ca/pdfs/400971-RMandR-Rehabilitation-Referral-Form-2017-03.pdf

PULMONARY REHABILITATION PROGRAM

• No cardiac disease which prevents partaking in exercise (most undergo Stage II exercise...test at HDH)...• No significant musculoskeletal issues that preclude meaningful participation (Some...•...
https://www.southeasthealthline.ca/pdfs/SMOL-Referral-Form-1.pdf

Alz Society Kingston Referral Form.pdf

Alzheimer’s Disease Vascular Dementia Frontotemporal Dementia...Lewy-Body Dementia Mixed Dementia MCI...Korsakoff’s Syndrome Dementia due to head trauma...Dementia due to other illness...
https://www.southeasthealthline.ca/pdfs/Alz%20Society%20Kingston%20Referral%20Form.pdf

Referral_Form_Wound_Foot_Care.pdf

Client has: □ Diabetes □ Vascular Disease (M.I. .../ Stroke, PVD, etc.) □ Other Chronic Illness...Referral for: □ Open wound/foot ulcer or infection (high priority)...□ Advanced foot...
https://www.southeasthealthline.ca/pdfs/Referral_Form_Wound_Foot_Care.pdf

“APPLICATION TO REGISTER” For Health Services

Do you have any conditions or diseases that have not been listed? ...If so please list:...Do you take Aspirin or any Blood thinners? ...______________________________________...Have you ever been...
https://www.southeasthealthline.ca/pdfs/BQWCHC_application_referral_form_oral_Health_Services.pdf

rac_lbp_patient_intake_form_march_2020.pdf

 Heart Attack/Coronary Artery Disease No Yes  Ulcer or Stomach Disease No Yes... Heart Failure No Yes  Thyroid Disease No Yes... Lung Disease (e.g. ...asthma,...
https://www.southeasthealthline.ca/pdfs/rac_lbp_patient_intake_form_march_2020.pdf

AMHS-KFLA Fillable Referral Form 2019

AMHS-KFLA...Southeast Ontario Addictions & Mental Health Services Access Form...AMHS-KFLA...This form is to be completed by Primary Health Care and other Health Services Providers...FIELDS MARKED WITH AN...
https://www.southeasthealthline.ca/pdfs/amhs-kfla_addictions_mental_health_kingston_referral_form.pdf

Microsoft Word - CPC Patient Information Sheet (2024-05-08) - EN

BussieDh...Ministry of Health ...Ontario Community Physiotherapy Clinic...Program: Patient Information...Questions? ...Please visit:...www.ontario.ca/physiotherapy...Ontario’s Community Physiotherapy...
https://www.southeasthealthline.ca/pdfs/Napanee%20Physiotherapy%20and%20Rehabilitation%20-%20OHIP%20Insured%20Physiotherapy%20Information.pdf

as_first_link_referral_form.pdf

Family dynamics Infectious diseases Infestation/Squalor Pets Physical Environment...Recent hospitalizations Responsive behaviours Smoking Weapons Other:...Person with Dementia Name (probable or...
https://www.southeasthealthline.ca/pdfs/as_first_link_referral_form.pdf