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Health Screen Visiting Electives
… body. For those with no regulatory body, the local Medical Officer of Health or OHSS can provide advice with … please go to the link: https://www.sjhc.london.on.ca/medical-affairs/resources/health-review Submit completed … 5W9 519-685-8500 ext. 52286 Fax: 519-685-8374 Email: OHSS-medicalaffairs@lhsc.on.ca Revised 2021/03/23 Page 1 of 5 …
CITY-WIDE HEALTH SCREEN FOR VISITING ELECTIVES Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/MM/DD): First Name: Last Name: Gender: Date of Birth (YYYY/MM/DD): Family Physician: Phone: Email: Emergency Contact Person: Contacts Phone: Prim...
Health_Review_Form_For_Volunteers_FINAL 20190703.docx
… 2019 Do you have any food/drug allergies or any emergent medical conditions (e.g., asthma, epilepsy, diabetes, heart … 2019 Do you have any food/drug allergies or any emergent medical conditions (e.g., asthma, epilepsy, diabetes, heart …
HEALTH REVIEW FORM VOLUNTEER CO-OP STUDENT POST SECONDARY STUDENT SPONSORED STUDENT Proof of immunization is required and includes any of the following: Vaccination records from yellow immunization cards, Immigration records, notes from a physicians office, copies of laboratory reports (titre levels...
Health_Review_Form_For_Volunteers_FINAL 20190703.pdf
… 2019 Do you have any food/drug allergies or any emergent medical conditions (e.g., asthma, epilepsy, diabetes, heart … 2019 Do you have any food/drug allergies or any emergent medical conditions (e.g., asthma, epilepsy, diabetes, heart …
July 2019 HEALTH REVIEW FORM VOLUNTEER CO-OP STUDENT POST SECONDARY STUDENT SPONSORED STUDENT Proof of immunization is required and includes any of the following: Vaccination records from yellow immunization cards, Immigration records, notes from a physicians office, copies of laboratory reports (ti...
Health_Review_Form_Paid_Private_Hire_FINAL 20190326.pdf
… Do you have any food/drug allergies or any emergent medical conditions (eg, asthma, epilepsy, diabetes, heart … Do you have any food/drug allergies or any emergent medical conditions (eg, asthma, epilepsy, diabetes, heart …
February 2019 HEALTH REVIEW FORM Paid Staff Private Hire St. Josephs Mt. Hope Parkwood Institute Main Building Parkwood Institute Mental Health Care Southwest Centre In order to fulfill the terms and conditions of your employment offer, the following information must be provided to Occupation...
health_review_form_paid_private_hire_final_2022-02-10.pdf
… proof. Do you have any food/drug allergies or any emergent medical conditions (e.g., asthma, epilepsy, diabetes, heart … proof. Do you have any food/drug allergies or any emergent medical conditions (e.g., asthma, epilepsy, diabetes, heart …
August 2021 HEALTH REVIEW FORM Paid Staff Private Hire St. Josephs Mt. Hope Parkwood Institute Main Building Parkwood Institute Mental Health Care Southwest Centre To fulfill the terms and conditions of your employment offer, the following information must be provided to Occupational Health a...
Health_Screen_Form_Electives_FINAL 20180423_0.pdf
… body. For those with no regulatory body, the local Medical Officer of Health or OHSS can provide advice with … found at the following link https://www.sjhc.london.on.ca/medical-affairs/resources/health-review N95 Fit Testing Fit … model 8210 • 3M model 1860S https://www.sjhc.london.on.ca/medical-affairs/resources/health-review CITY-WIDE HEALTH …
GUIDELINES FOR COMPLETION OF CITY-WIDE HEALTH SCREEN FOR VISITING ELECTIVES Revised 20160817 Page 1 of 4 (MUST Provide Proof) Past LHSC/St. Josephs Record: Yes No Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/MM/DD): First Name: Last Na...
Health_Screen_Form_Electives_FINAL 20180423.pdf
… body. For those with no regulatory body, the local Medical Officer of Health or OHSS can provide advice with … link https://www.sjhc.london.on.ca/sites/default/files/pdf/medicalaffairs_tbsurvey.pdf N95 Fit Testing Fit Testing is … 1860S https://www.sjhc.london.on.ca/sites/default/files/pdf/medicalaffairs_tbsurvey.pdf CITY-WIDE HEALTH SCREEN FOR …
GUIDELINES FOR COMPLETION OF CITY-WIDE HEALTH SCREEN FOR VISITING ELECTIVES Revised 20160817 Page 1 of 4 (MUST Provide Proof) Past LHSC/St. Josephs Record: Yes No Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/MM/DD): First Name: Last Na...
Health_Screen_Form_Electives_FINAL_20190227.pdf
… body. For those with no regulatory body, the local Medical Officer of Health or OHSS can provide advice with … found at the following link https://www.sjhc.london.on.ca/medical-affairs/resources/health-review N95 Fit Testing Fit … https://www.sjhc.london.on.ca/medical-affairs/resources/health-review CITY-WIDE HEALTH …
GUIDELINES FOR COMPLETION OF CITY-WIDE HEALTH SCREEN FOR VISITING ELECTIVES Revised 20190227 Page 1 of 4 (MUST Provide Proof) Past LHSC/St. Josephs Record: Yes No Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/MM/DD): First Name: Last Na...
Health_Screen_Form_Electives_FINAL_20190322.pdf
… body. For those with no regulatory body, the local Medical Officer of Health or OHSS can provide advice with … found at the following link https://www.sjhc.london.on.ca/medical-affairs/resources/health-review N95 Fit Testing Fit … model 8210 • 3M model 1860S https://www.sjhc.london.on.ca/medical-affairs/resources/health-review CITY-WIDE HEALTH …
GUIDELINES FOR COMPLETION OF CITY-WIDE HEALTH SCREEN FOR VISITING ELECTIVES Revised 20190322 Page 1 of 4 (MUST Provide Proof) Past LHSC/St. Josephs Record: Yes No Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/MM/DD): First Name: Last Na...
health_screen_form_electives_final_20190423_-_june_2020.pdf
… body. For those with no regulatory body, the local Medical Officer of Health or OHSS can provide advice with … found at the following link https://www.sjhc.london.on.ca/medical-affairs/resources/health-review N95 Fit Testing Fit … model 8210 • 3M model 1860S https://www.sjhc.london.on.ca/medical-affairs/resources/health-review CITY-WIDE HEALTH …
GUIDELINES FOR COMPLETION OF CITY-WIDE HEALTH SCREEN FOR VISITING ELECTIVES Revised 20190322 Page 1 of 4 (MUST Provide Proof) Past LHSC/St. Josephs Record: Yes No Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/MM/DD): First Name: Last Na...
Health_Screen_Form_Electives_FINAL_20190423.pdf
… body. For those with no regulatory body, the local Medical Officer of Health or OHSS can provide advice with … found at the following link https://www.sjhc.london.on.ca/medical-affairs/resources/health-review N95 Fit Testing Fit … model 8210 • 3M model 1860S https://www.sjhc.london.on.ca/medical-affairs/resources/health-review CITY-WIDE HEALTH …
GUIDELINES FOR COMPLETION OF CITY-WIDE HEALTH SCREEN FOR VISITING ELECTIVES Revised 20190322 Page 1 of 4 (MUST Provide Proof) Past LHSC/St. Josephs Record: Yes No Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/MM/DD): First Name: Last Na...
Health_Screen_Form_Electives_FINAL.pdf
… body. For those with no regulatory body, the local Medical Officer of Health or OHSS can provide advice with … link https://www.sjhc.london.on.ca/sites/default/files/pdf/medicalaffairs_tbsurvey.pdf N95 Fit Testing Fit Testing is … 1860S https://www.sjhc.london.on.ca/sites/default/files/pdf/medicalaffairs_tbsurvey.pdf CITY-WIDE HEALTH SCREEN FOR …
GUIDELINES FOR COMPLETION OF CITY-WIDE HEALTH SCREEN FOR VISITING ELECTIVES Revised 20160817 Page 1 of 4 (MUST Provide Proof) Past LHSC/St. Josephs Record: Yes No Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/MM/DD): First Name: Last Na...
health_screen_form_medical_affairs_city_wide_prof_res_fellows_2022-04-14_fillalbe.pdf
… body. For those with no regulatory body, the local Medical Officer of Health or OHSS can provide advice with … please go to the link: https://www.sjhc.london.on.ca/medical-affairs/resources/health-review Residents, Clinical … 5W9 519-685-8500 ext. 52286 Fax: 519-685-8374 Email: OHSS-medicalaffairs@lhsc.on.ca St. Joseph’s Health Care London …
1 CITY-WIDE HEALTH SCREEN FOR PROFESSIONAL STAFF/RESIDENTS/CLINICAL FELLOWS Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/MM/DD): First Name: Last Name: Gender: Date of Birth (YYYY/MM/DD): Family Physician: CPSO #: Phone: Email: Emergency...
Health_Screen_Form_Medical_FINAL 20180423_0.pdf
… go to the link: https://www.londonhospitals.ca/departments/medical_affairs/post_grad/Orientation/HealthReview.php All … body. For those with no regulatory body, the local Medical Officer of Health or OHSS can provide advice with … to accommodate. https://www.londonhospitals.ca/departments/medical_affairs/post_grad/Orientation/HealthReview.php …
Revised 20170206 Page 1 of 4 GUIDELINES FOR COMPLETION OF CITY-WIDE HEALTH SCREEN FOR PROFESSIONAL STAFF/RESIDENTS/CLINICAL FELLOWS (MUST Provide Proof) Past LHSC/St. Josephs Record: Yes No Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/...
Health_Screen_Form_Medical_FINAL 20180423_1.pdf
… please go to the link: https://www.sjhc.london.on.ca/medical-affairs/resources/health-review All professional … body. For those with no regulatory body, the local Medical Officer of Health or OHSS can provide advice with … ability to accommodate. https://www.sjhc.london.on.ca/medical-affairs/resources/health-review Revised 20180423 …
Revised 20170206 Page 1 of 4 GUIDELINES FOR COMPLETION OF CITY-WIDE HEALTH SCREEN FOR PROFESSIONAL STAFF/RESIDENTS/CLINICAL FELLOWS (MUST Provide Proof) Past LHSC/St. Josephs Record: Yes No Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/...
Health_Screen_Form_Medical_FINAL 20180423_2.pdf
… please go to the link: https://www.sjhc.london.on.ca/medical-affairs/resources/health-review All professional … body. For those with no regulatory body, the local Medical Officer of Health or OHSS can provide advice with … ability to accommodate. https://www.sjhc.london.on.ca/medical-affairs/resources/health-review Revised 20180423 …
Revised 20170206 Page 1 of 4 GUIDELINES FOR COMPLETION OF CITY-WIDE HEALTH SCREEN FOR PROFESSIONAL STAFF/RESIDENTS/CLINICAL FELLOWS (MUST Provide Proof) Past LHSC/St. Josephs Record: Yes No Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/...
Health_Screen_Form_Medical_FINAL 20180423_3.pdf
… please go to the link: https://www.sjhc.london.on.ca/medical-affairs/resources/health-review All professional … body. For those with no regulatory body, the local Medical Officer of Health or OHSS can provide advice with … ability to accommodate. https://www.sjhc.london.on.ca/medical-affairs/resources/health-review Revised 20180423 …
Revised 20170206 Page 1 of 4 GUIDELINES FOR COMPLETION OF CITY-WIDE HEALTH SCREEN FOR PROFESSIONAL STAFF/RESIDENTS/CLINICAL FELLOWS (MUST Provide Proof) Past LHSC/St. Josephs Record: Yes No Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/...