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Canadian Trained Professional Staff in an Academic Appointment New positions requires that Part A of the Position/Candidate Impact Summary Form be completed and request form submitted by Department to Medical Affairs for the Joint Professional Staff Human Resource Committee (JPSHRC) to Review. The A...
Non-Canadian Trained Professional Staff in an Academic Appointment New positions requires that Part A of the Position/Candidate Impact Summary Form be completed and request form submitted by Department to Medical Affairs for the Joint Professional Staff Human Resource Committee (JPSHRC) to Review. T...
Personal Information Bank (PIB) Details Title: Recruitment Location of Records: Human Resources, department leader files Description: Records relating to the recruitment of staff for permanent, part-time and contract job postings. May include information on applicant screening and testing, conductin...
Digital Stimulation (Rectal Touches) Contact your Doctor or Nurse for more information. SELF CARE Originally written by: Sharon Ryan. 2015 University Health Network - Toronto Rehab. All rights reserved. Disclaimer: Information is provided for educational purposes only. Consult a qualified health pro...
Digital Stimulation (Rectal Touches) Contact your Doctor or Nurse for more information. SELF CARE Originally written by: Sharon Ryan. 2015 University Health Network - Toronto Rehab. All rights reserved. Disclaimer: Information is provided for educational purposes only. Consult a qualified health pro...
W EL LI NG TO N RO AD C O M M I S S I O N E R S R O A D E A S T WESTERN COUNTIES WING ARTHUR J. HOBBINS BUILDING BU LOT 1 Parking Garage LOT 3 LOT 5 E D B C A W ES TE R N C O U N TI ES R O AD WATERMAN AVE Parking Zone Legend Barrier Free Parking LOT 2 Entrance *EXIT RIGHT TURN ONLY *ENTRY RIGHT TURN...
Osteoporosis and Bone Disease Program 268 Grosvenor St. London, ON N6A 4V2 Phone: 519-646-6000 ext. 64434 Fax: 519-646-6043 PATIENT INFORMATION Name: Date of Birth: Health Card: Address: Telephone: Family Physican: Reason For Consult: Osteoporosis Has the patient had a prior consultation with us for...
Referral Form Roth | McFarlane Hand and Upper Limb Centre St. Josephs Hospital 268 Grosvenor St. London, ON N6A 4V2 Telephone: 519-646-6100 ext.64944 Fax: 519-646-6049PATIENT INFORMATION Surname: ________________________Given Name: ____________________Email: ____________________________ Date of birt...
Comprehensive Outpatient Rehabilitation Program Parkwood Institute, Arthur J. Hobbins Building PO Box 5777 STN B, London, ON, N6A4V2 Tel: 519-685-4578 Fax: 519-685-4802 Referral Form FOR OFFICE USE ONLY Referral Date: MR#: Contact Date: Intake Date: CLIENT INFORMATION Name: DOB (YY/MM/DD): Address: ...
Peripheral Nerve Clinic Referral Form EMG Laboratory Parkwood Institute, Main Building St. Joseph Health Care London 550 Wellington Rd, London, ON N6C 0A7 P: 519 646-6100 ext. 65364 F: 519 646-6174 Please complete and fax this form to 519 646-6174 Patient information: Name: Date of Birth: Address (i...
ULTRASOUND REQUISITION Site: London Health Sciences Centre Vic/Childrens F: 519-667-6826 St. Josephs Health Care London F: 519-646-6204 London Health Sciences Centre UH F: 519-633-3034 PATIENT INFORMATION: Surname: First Name: Middle Initial: Gender: Date of Birth (YYYY-MM-DD): Street Address: Apa...
Office Use Only Date Referral Received:____________ Parkwood Institute MR#:__________ Parkwood Institute Acquired Brain Injury Program 550 Wellington Rd. London, Ontario N6C 0A7 Telephone: 519 685 4064 Fax: (519) 685-4551 Toll free: 1-866-484-0445 Client Information Name: Health Card #: Address: Tow...
FOR OFFICE USE ONLY Date received Appointment with Appointment date Appointment time Patient notified Referring physician notified \\lhdat12\vol5\Users\BRUCEDA\Windows\Desktop\Diabetes Endocrinology OPD Referral Form 2017 03 01cv2.docx OUTPATIENT DIABETES & ENDOCRINOLOGY REFERRAL FORM Copies of this...
FOR OFFICE USE ONLY Date received Appointment with Appointment date Appointment time Patient notified Referring physician notified \\lhdat12\vol5\users\BRUCEDA\Windows\Desktop\DIA -referral form - Diabetes Endocrinology OPD Referral Form 2017 03 01c.docx OUTPATIENT DIABETES & ENDOCRINOLOGY REFERRAL ...
July 2017 Physiatry Outpatient Acquired Brain Injury Referral Form Parkwood Institute 550 Wellington Rd London N6C 0A7 Phone: 519-685-4579 Fax: 519-685-4075 Patient Name: Referring Physician: DOB (YY/MM/DD): Phone: OHIP #: Fax: Address: Billing Number: Referral Date: Contact phone: Physicians Signat...
Copies of this form available at: http://www.sjhc.london.on.ca/diabetes-endocrinology-centre/referral-forms Revised: March 13, 2019 OUTPATIENT DIABETES & ENDOCRINOLOGY REFERRAL FORM Please complete all sections of this form for all elective referrals (complete URGENT section only if indicated). You ...
Parkwood Institute Driver Assessment and Rehabilitation Centre Driver Assessment and Rehabilitation Program/DriveABLE Mailing address Location PO BOX 5777, STN B 550 Wellington Road London, ON N6A 4V2 London ON N6C 0A7 Tel: (519) 685-4070 Fax: (519) 685-4066 Referral (Please forward any relevant med...
Regional Best Practice Guidelines Initiative in Long Term Care This initiative has been developed by the Ministry of Health and Long Term Care to support long term care homes (LTCH) in adopting evidence-based practices that support systematic and consistent approaches to quality care for residents. ...