Services de Santé pour South West Ontario

LHSC EMG Information Pamphlet 2009

Date:....................................... ...Time: ...........................................c University Hospital...IF YOU CANNOT COME AT THIS TIME...PLEASE NOTIFY US AT...Telephone...

http://www.lignesantesud-ouest.ca/pdfs/EMGInformationPamphlet.pdf

alexandrahospital_oxfordcountycardiacrehabilitationandsecondarypreventionprogram_referralform2023.pdf

... Team with suggestions only for pharmacologic treatment to the primary or referring physician....Date (mm/dd/yy) Referring Physician and Billing number Physician Signature...(print clearly)

http://www.lignesantesud-ouest.ca/pdfs/alexandrahospital_oxfordcountycardiacrehabilitationandsecondarypreventionprogram_referralform2023.pdf

St. Joseph's Health Care London Geriatric Referral Form 2006

Facility: ____________________________________________________ Date of Admission: ________________________...Address/Unit: _____________________________________________ Phone #:...

http://www.lignesantesud-ouest.ca/pdfs/SJ_Geriatric_Referral_Form.pdf

YTC-Diversion-Screening-Form.pdf

Joelene Bamford – Youth Mental Health Court Worker, Youth Therapeutic Court...The London Family Court Clinic...200-254 Pall Mall St. ...London, ON N6A 5P6...Ph: (519)280-4885 Fax:...

http://www.lignesantesud-ouest.ca/pdfs/YTC-Diversion-Screening-Form.pdf

Elgin St Thomas Public Health - Environmental Health - Possible Animal Rabies Exposure Report Form

Date of Incident ____________________________________Date Seen by Dr.________________________________...Describe incident:...

http://www.lignesantesud-ouest.ca/pdfs/ElginStThomasPublicHealth_RabiesReportForm.pdf

JessicasHouse_ResidentialHospiceReferralForm_May7_2020.pdf

DATE OF REFERRAL (yyyy/mm/dd):...PATIENT’S PERSONAL INFORMATION...Last Name First Name Date of Birth...(yyyy/mm/dd)...Address Apt # City/Province Postal Code...Home Telephone Preferred...

http://www.lignesantesud-ouest.ca/pdfs/JessicasHouse_ResidentialHospiceReferralForm_May7_2020.pdf

WECHC_ReferralApplicationForm_2019.docx

Health information: Health card number: Medical Provider: Other : Other agency involvement: Name of agency Past involvement (list dates) Current involvement (list dates) Reason for...

http://www.lignesantesud-ouest.ca/pdfs/WECHC_ReferralApplicationForm_2019.docx

Ontario Ministry of Agriculture, Food and Rural Affairs- 2017 Perth County Rural Guide

www.facebook.com/theperthcountyholsteinclub...Perth County Rural Guide – 2017 Edition...compiled by the Ministry of Agriculture, Food and Rural Affairs – Stratford Resource Centre...14...ONTARIO...

http://www.lignesantesud-ouest.ca/pdfs/OMAFRA_2017_Perth_County_Rural_Guide.pdf

Brightshores Health System - Owen Sound Hospital - Grey Bruce District Stroke Centre - Community Stroke Rehabilitation Team_November 2025.pdf

CT availability is limited; requested dates will be accommodated where possible....SCREENING & PRECAUTIONS...RENAL ASSESSMENT...☐ No known kidney issues ☐ Known hypersensitivity to contrast agents

http://www.lignesantesud-ouest.ca/pdfs/Brightshores%20Health%20System%20-%20Owen%20Sound%20Hospital%20-%20Grey%20Bruce%20District%20Stroke%20Centre%20-%20Community%20Stroke%20Rehabilitation%20Team_November%202025.pdf

Brightshores Health System - Owen Sound Hospital - Grey Bruce District Stroke Centre - Stroke Prevention Clinic Referral Form - Jan 2026