Champlain
Renseignements concernant les patients et renvois
310-2272
Sans frais au Canada :1 800 538-0520
Télécopieur :613 745-6984
TTY :711
Visitez Lignesanté Champlain
Pour demander des services de soins à domicile et en milieu communautaire, veuillez remplir ce formulaire de demande en ligne, ou appelez-nous 1 800 538-0520 (sans frais) ou 613 745-5525.
Emplacements des bureaux de Champlain
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Ottawa (Corporate Office and mailing address)
4200, rue Labelle
Bureau 100
Ottawa, ON, K1J 1J8
Sans frais : 1 866 902-5446
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Bell’s Corners
301, promenade Moodie
Bureau 105
Ottawa, ON, K2H 9C4
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Cornwall
709, rue de la Fabrique
Cornwall, ON, K6H 7K7
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Hawkesbury
119, rue Main Est
bureau 101
Hawkesbury, ON, K6A 1A1
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Pembroke
1100, rue Pembroke Est
Pembroke, ON, K8A 6Y7
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Renfrew
850, chemin O’Brien
Unité 8
Renfrew, ON, K7V 3Z4
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Winchester
530, rue Fred
Bureau D, CP 209
Winchester, ON, K0C 2K0
Compliments et Inquiétudes
Veuillez transmettre vos commentaires à votre coordonnateur de soins. Vous pouvez aussi communiquer vos compliments ou préoccupations d’une des manières suivantes :
Par courriel : champlainquality@hccontario.ca
Téléphone : 1 844 454-1322
Salle de nouvelles et relations avec les médias
Visitez notre salle de nouvelles pour en savoir plus sur les actualités et événements.
Pour toute demande de renseignements des médias, veuillez envoyer un courriel à l’adresse HCCSSmedia@hccontario.ca.
Pour les demandes ne provenant pas des médias concernant Services de soutien à domicile et en milieu communautaire, et pour mieux vous servir, veuillez visiter la page Pour nous joindre pour obtenir des coordonnées supplémentaires
Documents d’accessibilité
Publications
- When Death Occurs at Home
- Welcome Kit – English
- Telehomecare Remote Monitoring COPD HF Patient Information
- Telehomecare Remote Monitoring COPD HF Physician Information
- Home First
- Long-Term Care Home List
- MAID FAQ
- MAID Information for Physicians and Nurses – English
- Primary Care Resource
- Regional Palliative Consultation Team Brochure
Forms
| Title | Summary | Region | Last Modified | Category | File Type | File Size | Link | hf:doc_tags | hf:doc_categories | hf:file_type |
|---|---|---|---|---|---|---|---|---|---|---|
| Application for Determination of Eligibility for LTC – English | Application for Determination of Eligibility for Long-Term Care – English | Champlain | January 9, 2023 | Forms | 250 KB | champlain | forms | |||
| Authorization for Release of Personal Health Information Form | Authorization for Release of Personal Health Information Form | Champlain | September 19, 2022 | Forms | 522 KB | champlain | forms | |||
| Authorization to Collect, Use, Disclose PHI Form – Bilingual | Authorization to Collect, Use, Disclose PHI Form – Bilingual | Champlain | September 22, 2022 | Forms | 450 KB | champlain | forms | |||
| Community IV Therapy Venous Access Algorithm | Community IV Therapy Venous Access Algorithm | Champlain | September 19, 2022 | Forms | 118 KB | champlain | forms | |||
| Demande de détermination d’admissibilité pour une admission en foyer de soins de longue durée | Demande de détermination d’admissibilité pour une admission en foyer de soins de longue durée | Champlain | September 21, 2022 | Forms | 33 KB | champlain | forms | |||
| Email Consent and Use Form – English | … | Champlain | September 22, 2022 | Forms | 362 KB | champlain | forms | |||
| Email Consent and Use Form – French | Email Consent and Use Form – French | Champlain | September 22, 2022 | Forms | 307 KB | champlain | forms | |||
| Family Managed Home Care Application Form – English | Family Managed Home Care Application Form – English | Champlain | September 22, 2022 | Forms | 356 KB | champlain | forms | |||
| Family Managed Home Care Application Form – French | Family Managed Home Care Application Form – French | Champlain | September 22, 2022 | Forms | 338 KB | champlain | forms | |||
| First Dose Parenteral Administration Form | First Dose Parenteral Administration Form | Champlain | September 19, 2022 | Forms | 554 KB | champlain | forms | |||
| Infusion Therapy – IV Remdesivir Referral Form | Infusion Therapy – IV Remdesivir Referral Form | Champlain | October 20, 2023 | Forms | 188 KB | champlain | forms | |||
| Infusion Therapy Venous Access Referral Form | Infusion Therapy Venous Access Referral Form | Champlain | September 19, 2022 | Forms | 382 KB | champlain | forms | |||
| Integrated Bruyere Outpatient and Community Stroke Rehabilitation Referral Form | Integrated Bruyere Outpatient and Community Stroke Rehabilitation Referral Form | Champlain | September 13, 2023 | Forms | 237 KB | champlain | forms | |||
| Long-Term Care Home Crisis Choice List – Bilingual | Long-Term Care Home Crisis Choice List – Bilingual | Champlain | June 20, 2023 | Forms | 400 KB | champlain | forms | |||
| Long-Term Care Home Choice List – English | Long-Term Care Home Choice List – English | Champlain | October 16, 2023 | Forms | 207 KB | champlain | forms | |||
| Long-Term Care Home Choice List – French | Long-Term Care Home Choice List – French | Champlain | October 16, 2023 | Forms | 214 KB | champlain | forms | |||
| Long-Term Care Home Short Stay Interim Choice List – English | Long-Term Care Home Short Stay Interim Choice List – English | Champlain | October 16, 2023 | Forms | 114 KB | champlain | forms | |||
| Long-Term Care Home Short Stay Interim Choice List – French | Long-Term Care Home Short Stay Interim Choice List – French | Champlain | October 16, 2023 | Forms | 106 KB | champlain | forms | |||
| Long-Term Care Home Short-Stay Respite Choice List – English | Long-Term Care Home Short Stay Respite Choice List – English | Champlain | August 28, 2023 | Forms | 156 KB | champlain | forms | |||
| Long-Term Care Home Short-Stay Respite Choice List – French | Long-Term Care Home Short Stay Respite Choice List – French | Champlain | August 28, 2023 | Forms | 553 KB | champlain | forms | |||
| LTC Counselling Checklist – English | Long-term care counselling checklist for community patients. | Champlain | October 11, 2023 | Forms | 161 KB | champlain | forms | |||
| LTC Counselling Checklist – French | Patients dans la communauté – Liste de vérification des conseils pour admission en soins de longue durée | Champlain | October 11, 2023 | Forms | 165 KB | champlain | forms | |||
| LTC Counselling Checklist for Hospital Patients – English | Long-term care counselling checklist for hospital patients. | Champlain | October 11, 2023 | Forms | 844 KB | champlain | forms | |||
| LTC Counselling Checklist for Hospital Patients – French | Liste de vérification pour les patients hospitalisés – Renseignements sur les soins de longue durée | Champlain | October 11, 2023 | Forms | 814 KB | champlain | forms | |||
| Medical Referral Form | Medical Referral Form | Champlain | September 19, 2022 | Forms | 389 KB | champlain | forms | |||
| Medical Referral Infusions Pain and Symptom Management | Medical Referral Infusions Pain and Symptom Management | Champlain | September 19, 2022 | Forms | 1 MB | champlain | forms | |||
| Negative Pressure Wound Therapy Prescription Form | Negative Pressure Wound Therapy Prescription Form | Champlain | September 19, 2022 | Forms | 525 KB | champlain | forms | |||
| Referral Form for Home and Community Care Services | Champlain referral form for home and community care services | Champlain | February 24, 2023 | Forms | 442 KB | champlain | forms | |||
| Regional Palliative Consultation Team Referral Form | Regional Palliative Consultation Team Referral Form | Champlain | September 19, 2022 | Forms | 233 KB | champlain | forms | |||
| Symptom Response Kit for End-of-Life Order Form – Champlain | Symptom Response Kit for End-of-Life Order Form – Champlain | Champlain | January 23, 2023 | Forms | 333 KB | champlain | forms | |||
| Telehomecare COVID-19 Remote Monitoring Referral Form – FR | Telehomecare COVID-19 Remote Monitoring Referral Form – FR | Champlain | September 19, 2022 | Forms | 381 KB | champlain | forms | |||
| TeleHomeCare Remote Monitoring Program Referral Form | … | Champlain | February 1, 2023 | Forms | 238 KB | champlain | forms | |||
| Telehomecare Remote Monitoring Program Referral Form-FR | … | Champlain | February 1, 2023 | Forms | 241 KB | champlain | forms |