Services de Santé pour Hamilton Niagara Haldimand Brant

Community Internal Medicine Rapid Access Clinic Referral Form

COMMUNITY INTERNAL MEDICINE...RAPID ACCESS CLINIC REFERRAL...(C-IMRAC)...✍ Initial all boxes and entries...q Charlton Campus...q King Campus...q West 5th Campus...PD 8975 (2015-04) HIM Page 1 of 2...1.

http://www.lignesantehnhb.ca/pdfs/C-IMRAC%20Referral%20Form.pdf

Hepatitis C Care Clinc Referral Form

Hepatitis C Care Clinic...Port Colborne General Site / New Port Centre...Port Colborne, ON L3K 2N7...Phone: (905) 378-4647 Ext. ...32554...Confidential Fax: (905) 834-6014...Main Clinic Satelitte Clinic

http://www.lignesantehnhb.ca/pdfs/Hepatitis%20C%20Care%20Clinic%20Referral%20Form.pdf

Chapel Heights Respite Recovery Health Care Patient Card

7373 Niagara Square Drive, Niagara Falls, Ontario L2H 1J2...905.371.0121 • contact@chapelheights.ca...www.chapelheights.ca...NEED A RESPITE...OR RECOVERY STAY?...ENHANCED CARE...& RECOVERY...☛ 24 Hour

http://www.lignesantehnhb.ca/pdfs/Chapel%20Heights%20Respite%20Recovery%20Health%20Care%20Patient%20Card.pdf

Bethlehem Housing Projects of Niagara

Dick...Bethlehem Housing & Support Services...St. ...Catharines...151 James Street...Unit Size Preferred  1 Bedroom  1 B. ...accessible  2 bedroom  3 Bedroom...1. ...Applicant...Last Name...First...

http://www.lignesantehnhb.ca/pdfs/GenesisCourtApplicationForm.pdf

Bethlehem Housing Projects of Niagara

Dick...BETHLEHEM HOUSING & SUPPORT SERVICES...Niagara Falls...6185 Kalar Road...Unit Size Preferred  1 Bedroom  1 B. accessible  2 bedroom  2 B. ...accessible  3 Bedroom...1. ...Applicant...Last...

http://www.lignesantehnhb.ca/pdfs/KenmoreCourtApplicationForm.pdf

Michael G. DeGroote Pain Clinc Referral Form

Please note that all referrals must be completed on this form. ...Please provide as much detail as possible to...ensure your patient is triaged appropriately....We recommend non-urgent OHIP referred...

http://www.lignesantehnhb.ca/pdfs/Michael%20G%20DeGroote%20Pain%20Clinic%20Referral%20Form.pdf

Halton Diabetes Program Referral Form

Last name: First name: □ Male □ Female...Phone: Email:...Address:...Diabetes Diagnosis Duration In Years □ New □ 1-5 □ 6-10 □ 10+...Please attach blood work EDC: (dd/mm/yyyy )...□ Type 2...□ Hypertension...

http://www.lignesantehnhb.ca/pdfs/Halton%20Diabetes%20Program%20Referral%20Form.pdf

Developmental Pediatrics and Rehabilitation Professional Referral Form

McMaster Children's Hospital – RJCHC Site...Developmental Pediatrics & Rehabilitation Program...237 Barton Street East, Hamilton, ON L8L 2X2...January 2016...Phone: (905) 521-7950 Fax: (905) 577-8029

http://www.lignesantehnhb.ca/pdfs/Developmental%20Pediatrics%20and%20Rehabilitation%20Professional%20Referral%20Form.pdf

Contact Niagara Physician Referral Form

Physician Referral Form...Contact Niagara – The access point for child and youth counselling/psychiatry referral services within the...Niagara Region. ...Our intake process will ensure your referral will...

http://www.lignesantehnhb.ca/pdfs/Contact%20Niagara%20Physician%20Referral%20Form.pdf

Developmental Pediatrics and Rehabilitation Program Professional Referral Form

McMaster Children's Hospital – RJCHC Site...Developmental Pediatrics & Rehabilitation Program...237 Barton Street East, Hamilton, ON L8L 2X2...January 2016...Phone: (905) 521-7950 Fax: (905) 577-8029

http://www.lignesantehnhb.ca/pdfs/Developmental%20Pediatrics%20and%20Rehabilitation%20Program%20Professional%20Referral%20Form.pdf

LES SUJETS

RÉSULTATS DE LA RECHERCHE

Community Internal Medicine Rapid Access Clinic Referral Form

Hepatitis C Care Clinc Referral Form

Chapel Heights Respite Recovery Health Care Patient Card

Bethlehem Housing Projects of Niagara

Bethlehem Housing Projects of Niagara

Michael G. DeGroote Pain Clinc Referral Form

Halton Diabetes Program Referral Form

Developmental Pediatrics and Rehabilitation Professional Referral Form

Contact Niagara Physician Referral Form

Developmental Pediatrics and Rehabilitation Program Professional Referral Form