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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

Referral_Form_Wound_Foot_Care.pdf

who have high risk chronic illness and advanced foot problems that do not have any health...insurance coverage, or for those who have exhausted their insurance coverage for wound and...foot care...
https://www.southeasthealthline.ca/pdfs/Referral_Form_Wound_Foot_Care.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

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

or chronic condition that led to a decline...in function or movement....You must also:...1. ...Have a valid Ontario health card, and...2. ...Be 65 years or older, 19 years or...younger, or any age...
https://www.southeasthealthline.ca/pdfs/Napanee%20Physiotherapy%20and%20Rehabilitation%20-%20OHIP%20Insured%20Physiotherapy%20Information.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

Alz Society Kingston Referral Form.pdf

...s:...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 (i.e.
https://www.southeasthealthline.ca/pdfs/Alz%20Society%20Kingston%20Referral%20Form.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