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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...
https://www.southeasthealthline.ca/pdfs/SMOL-Referral-Form-1.pdf

AMHS-KFLA Fillable Referral Form 2019

CHRONIC ILLNESS...PSYCHIATRIC DIAGNOSIS(ES)...ANXIETY PERSONALITY DISORDER...BI-POLAR DISORDER...DEPRESSION SCHIZOPHRENIA...tDUAL DIAGNOSIS (Intellectual Disability & Mental Illness)...COMMENTS:
https://www.southeasthealthline.ca/pdfs/amhs-kfla_addictions_mental_health_kingston_referral_form.pdf

New Client Application Form - Sept 2023 -FINAL.pdf

Do you have any chronic diseases, or is there anything you would...like us to know about your health?...No Yes – Please explain below...Have you had a hard time receiving health services...
https://www.southeasthealthline.ca/pdfs/New%20Client%20Application%20Form%20-%20Sept%202023%20-FINAL.pdf

Maple Diabetes Referral Form.pdf

Maple Diabetes Prevention and Education Centre 1036 Princess St, Kingston, Ont, K7L 1H2, ph: 613-531-6086...Maple Diabetes Referral Form...New referrals will be individually triaged and assigned...
https://www.southeasthealthline.ca/pdfs/Maple%20Diabetes%20Referral%20Form.pdf

Client Onboarding Document

Your loved one may need to sit up to prevent...choking and may require gentle reminders to...swallow. ...Offer small amounts of food or...liquid, but don’t insist if they refuse. ...This is a...As...
https://www.southeasthealthline.ca/pdfs/Hospice%20Guide.pdf

CPHC Brochure

changes resulting from stroke....Exercise & Fall Prevention – classes are...combined with exercise and education and...are designed to help seniors stay active,...independent and “on their feet”.
https://www.southeasthealthline.ca/pdfs/sss_general_brochure_of_services.pdf

Kingston_Access_Services_Application_Form.pdf

Do your disabilities prevent you from reading and/or understanding signage, such as at a bus stop, or...digital signage on a bus?...[ ] Yes [ ] No [ ] Sometimes...3g. ...Do your disabilities...
https://www.southeasthealthline.ca/pdfs/Kingston_Access_Services_Application_Form.pdf

400292 Initial Assessment ABI OT

barkerd...400127 (2019/02) SIDE 1 OF 1 PERSONAL HEALTH INFORMATION RECORD FORM...P...E...R...S...O...N...L...H...E...L...T...H...N...F...O...R...M...T...IO...N... Physiotherapy  Occupational Therapy
https://www.southeasthealthline.ca/pdfs/pc_referral_form_seniors_day_rehabilitation_accident_recovery_centre.pdf

400292 Initial Assessment ABI OT

barkerd...400127 (2019/02) SIDE 1 OF 1 PERSONAL HEALTH INFORMATION RECORD FORM...P...E...R...S...O...N...L...H...E...L...T...H...N...F...O...R...M...T...IO...N... Physiotherapy  Occupational Therapy
https://www.southeasthealthline.ca/pdfs/pc-Rehabilitation-Therapy-Centre-Outpatient-Referral-2019-02.pdf

400292 Initial Assessment ABI OT

barkerd...400127 (2019/06) SIDE 1 OF 1 PERSONAL HEALTH INFORMATION RECORD FORM...P...E...R...S...O...N...L...H...E...L...T...H...N...F...O...R...M...T...IO...N... Physiotherapy... Speech Language...
https://www.southeasthealthline.ca/pdfs/400127-Rehabilitation-Therapy-Centre-Outpatient-Referral-2019-06.pdf