Champlain
Information and Referral
310-2222
Toll-free:1-800-538-0520
Fax:613-745-6984
TTY:711
Visit Champlain Healthline
Champlain Office Locations
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Ottawa (Corporate Office and Mailing Address)
4200 Labelle St,
Suite 100
Ottawa, ON, K1J 1J8
Toll-free: 1-866-902-5446
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Bell’s Corners
301 Moodie Dr.
Suite 105
Ottawa, ON, K2H 9C4
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Cornwall
709 Cotton Mill St.
Cornwall, ON, K6H 7K7
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Hawkesbury
119 Main St. East
Suite 101
Hawkesbury, ON, K6A 1A1
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Pembroke
1100 Pembroke St. East
Pembroke, ON, K8A 6Y7
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Renfrew
850 O’Brien Rd.
Unit 8
Renfrew, ON, K7V 3Z4
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Winchester
530 Fred St.
Suite D, PO Box 209
Winchester, ON, K0C 2K0
To request home and community care services, please use this form or contact us at 1-800-538-0520 (toll-free) or 613-745-5525.
Compliments and Concerns?
Please share your feedback with your care coordinator. You may also share compliments or concerns in the following ways:
Email: champlainquality@hccontario.ca
Phone: 1-844-454-1322
Newsroom and Media Relations
Visit our newsroom for more information on news and events.
For all media-related enquiries, please contact HCCSSmedia@hccontario.ca.
For non-media-related enquiries about Home and Community Care Support Services and to serve you best, please visit the Contact Us page to access additional contact information.
Accessibility Documents
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 | doc_tags_hfilter | doc_categories_hfilter | file_type_hfilter |
|---|---|---|---|---|---|---|---|---|---|---|
| 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 Venous Access Referral Form | Infusion Therapy Venous Access Referral Form | Champlain | September 19, 2022 | Forms | 382 KB | champlain | forms | |||
| Long-Term Care Counselling Checklist – English | Long-Term Care Counselling Checklist – English | Champlain | September 22, 2022 | Forms | 538 KB | champlain | forms | |||
| Long-Term Care Counselling Checklist – French | Long-Term Care Counselling Checklist – French | Champlain | September 22, 2022 | Forms | 280 KB | champlain | forms | |||
| Long-Term Care Home Crisis Choice List – Bilingual | Long-Term Care Home Crisis Choice List – Bilingual | Champlain | September 22, 2022 | Forms | 398 KB | champlain | forms | |||
| Long-Term Care Home Choice List – English | Long-Term Care Home Choice List – English | Champlain | March 14, 2023 | Forms | 457 KB | champlain | forms | |||
| Long-Term Care Home Choice List – French | Long-Term Care Home Choice List – French | Champlain | March 14, 2023 | Forms | 254 KB | champlain | forms | |||
| Long-Term Care Home Short Stay Interim Choice List – English | Long-Term Care Home Short Stay Interim Choice List – English | Champlain | September 22, 2022 | Forms | 504 KB | champlain | forms | |||
| Long-Term Care Home Short Stay Interim Choice List – French | Long-Term Care Home Short Stay Interim Choice List – French | Champlain | September 22, 2022 | Forms | 12 KB | champlain | forms | |||
| Long-Term Care Home Short-Stay Respite Choice List – English | Long-Term Care Home Short Stay Respite Choice List – English | Champlain | January 25, 2023 | Forms | 778 KB | champlain | forms | |||
| Long-Term Care Home Short-Stay Respite Choice List – French | Long-Term Care Home Short Stay Respite Choice List – French | Champlain | January 25, 2023 | Forms | 300 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 |