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The following is a list of common referral and order forms available to you to assist you in moving forward with your patient’s treatment, support and action plan.
- Assistive Devices Program : Ministry of Health
- Compassionate care leave benefit form
- Do Not Resuscitate (DNR) Confirmation Form (sample), if appropriate. This form can be ordered by visiting the Government of Ontario website.
- Home Oxygen Program: Ministry of Health
- Home and Community Care Support Services Mississauga Halton Palliative Care Referral Form
- Request for an Unlisted Drug Product – Exceptional Care Access Program
- Mississauga Halton LHIN Symptom Management Kit Order Form
- Mississauga Halton LHIN Symptom Management Kit Guidelines
Medical Certificiate of Death: Per the Vital Statistic Act, ensure the Medical Certificate of Death - Form 16 you are using is an original, current version (not a copy) of the prescribed form supplied by the Office of the Registrar General. To obtain a current version of this form, call your local Division Registrar's Office (City Hall), fax a written request to 1-807-343-7459 or call 1-807-343-7458 for more information.