Hamilton Niagara Haldimand Brant

Please use the Hospice Referral Form to request the palliative care outreach services in Brant.

To request the services of the Palliative Care Outreach Team in Burlington

To order the administration of ceftriaxone to patients being discharged from the Brantford Community Healthcare System (BCHS)

Information sheet about community nursing clinics located throughout HNHB.

Information sheet for patients about HNHB Community Nursing Clinics in French

To order first dose IV medications to be administered to patients in the community

To request the services of the Palliative Care Outreach Teams in Haldimand Norfolk

To request the services of the Palliative Care Outreach Team in Hamilton

Paramedic Services will communicate back to Home and Community Care Support Services using the HNHB Community Paramedicine Communication Form.

To order from HNHB’s medical supplies catalogue

Complete the Request for Home and Community Care Support Services HNHB form and fax it to the appropriate location. Refer to page 2 of the form for fax numbers.

Primary Care Partners: in addition to using the form above, you may also connect directly with the Care Coordinator aligned with your office/practice.

To order care relating to the Protocol for Home Parenteral Nutrition (PPN or TPN) for pediatric patients at McMaster Children’s Hospital

To refer a patient to (apply for) hospice and hospice-type services

For hospital partners who use Health Partner Gateway to receive patient referrals.

To order administration of influenza vaccine

To order intravenous iron replacement

To identify who will complete pronouncement and certification of death for an expected death at home

For Long-Term Care Partners in HNHB. Please complete and fax the Long-Term Care Home Referral for Service form to request one or more of the following services for residents:
• Nursing
• Wound Care
• Speech Language Pathology for Swallowing Assessment

To be completed and signed by an HCCSS Care Coordinator to refer a patient to Margaret’s Place for Palliative Overnight Respite care

To order nursing and IV starts for MAiD

To order general medications, including wound care and maintenance for urinary catheters

To order from HNHB’s medical supplies catalogue

Mental Health and Addictions Nursing Program Referral Form.

To request the services of the Mental Health & Additions Nurse, the patient must be:

1. A student registered in school and who is no older than 21 years of age (may include home instruction)
2. In need of services or related treatment to an identified and/or suspected mental health and/or addictions issue
3. Aware of and consenting to the referral

Additionally, there must be a clearly defined role for the Mental Health & Addictions Nurse

To order midline catheter maintenance

To order Milrinone Infusion Therapy for adult patients

To request negative pressure wound therapy for pressure ulcers, diabetic foot ulcers, arterial ulcers, venous ulcers and surgical wounds

To request negative pressure wound therapy for patients with special circumstances, e.g. patient has had a wide excision with skin graft or an STSG greater than 2 cm squared

To request the services of the Palliative Care Outreach Team in Niagara.

Nursing Care Centre locations throughout HNHB geography.

For the management of rapid-onset, unanticipated symptoms for patients nearing end–of-life and no longer able to swallow oral medications. The medication on this order form is limited to support short duration of symptom management (48 hours) until further medications are ordered. Note: See Palliative Care Symptom Response Guidelines for more info on how to use the form.

Guidelines how to use the Palliative Symptom Response Order Form.

Information sheet for patients and families.

To order Milrinone Infusion Therapy for pediatric patients

To clearly communicate a patient’s plan of care relating to the provision of CPR.

To order care relating to vascular access devices in children

To order care relating to vascular access devices in adults (in accordance with the Vascular Access Maintenance Protocol)

To order care relating to the Protocol for Home Parenteral Nutrition (PPN or TPN) for adult patients

For patients being discharged home from hospital with a new tracheostomy and laryngectomy care for patients being discharged home from hospital

To order IV vancomycin and/or aminoglycosides for patients in the community