Champlain

Champlain Office Locations

  • Ottawa (Corporate Office and Mailing Address)
    4200 Labelle St,
    Suite 100
    Ottawa, ON, K1J 1J8
    Toll-free:  1-866-902-5446
  • Bell’s Corners
    301 Moodie Dr.
    Suite 105
    Ottawa, ON, K2H 9C4
  • Cornwall
    709 Cotton Mill St.
    Cornwall, ON, K6H 7K7
  • Hawkesbury
    119 Main St. East
    Suite 101
    Hawkesbury, ON, K6A 1A1
  • Pembroke
    1100 Pembroke St. East
    Pembroke, ON, K8A 6Y7
  • Renfrew
    850 O’Brien Rd.
    Unit 8
    Renfrew, ON, K7V 3Z4
  • 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.

Forms

TitleSummaryRegionLast ModifiedCategoryFile TypeFile SizeLinkdoc_tags_hfilterdoc_categories_hfilterfile_type_hfilter
Application for Determination of Eligibility for Long-Term Care – English

Application for Determination of Eligibility for Long-Term Care – English

September 27, 2022pdf2 MBchamplainformspdf
Authorization for Release of Personal Health Information Form

Authorization for Release of Personal Health Information Form

September 19, 2022pdf522 KBchamplainformspdf
Authorization to Collect, Use, Disclose PHI Form – Bilingual

Authorization to Collect, Use, Disclose PHI Form – Bilingual

September 22, 2022pdf450 KBchamplainformspdf
Community IV Therapy Venous Access Algorithm

Community IV Therapy Venous Access Algorithm

September 19, 2022pdf118 KBchamplainformspdf
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

September 21, 2022pdf33 KBchamplainformspdf
Email Consent and Use Form – English

September 22, 2022pdf362 KBchamplainformspdf
Email Consent and Use Form – French

Email Consent and Use Form – French

September 22, 2022pdf307 KBchamplainformspdf
Family Managed Home Care Application Form – English

Family Managed Home Care Application Form – English

September 22, 2022pdf356 KBchamplainformspdf
Family Managed Home Care Application Form – French

Family Managed Home Care Application Form – French

September 22, 2022pdf338 KBchamplainformspdf
First Dose Parenteral Administration Form

First Dose Parenteral Administration Form

September 19, 2022pdf554 KBchamplainformspdf
Infusion Therapy Venous Access Referral Form

Infusion Therapy Venous Access Referral Form

September 19, 2022pdf382 KBchamplainformspdf
Long-Term Care Counselling Checklist – English

Long-Term Care Counselling Checklist – English

September 22, 2022pdf538 KBchamplainformspdf
Long-Term Care Counselling Checklist – French

Long-Term Care Counselling Checklist – French

September 22, 2022pdf280 KBchamplainformspdf
Long-Term Care Home Crisis Choice List – Bilingual

Long-Term Care Home Crisis Choice List – Bilingual

September 22, 2022pdf398 KBchamplainformspdf
Long-Term Care Home Choice List – English

Long-Term Care Home Choice List – English

September 19, 2022pdf782 KBchamplainformspdf
Long-Term Care Home Choice List – French

Long-Term Care Home Choice List – French

September 19, 2022pdf696 KBchamplainformspdf
Long-Term Care Home Short Stay Interim Choice List – English

Long-Term Care Home Short Stay Interim Choice List – English

September 22, 2022pdf504 KBchamplainformspdf
Long-Term Care Home Short Stay Interim Choice List – French

Long-Term Care Home Short Stay Interim Choice List – French

September 22, 2022pdf12 KBchamplainformspdf
Long-Term Care Home Short Stay Respite Choice List – English

Long-Term Care Home Short Stay Respite Choice List – English

September 22, 2022pdf656 KBchamplainformspdf
Long-Term Care Home Short Stay Respite Choice List – French

Long-Term Care Home Short Stay Respite Choice List – French

September 22, 2022pdf641 KBchamplainformspdf
Medical Referral Form

Medical Referral Form

September 19, 2022pdf389 KBchamplainformspdf
Medical Referral Infusions Pain and Symptom Management

Medical Referral Infusions Pain and Symptom Management

September 19, 2022pdf1 MBchamplainformspdf
Mental Health and Addictions Nurse Program Referral Form

Mental Health and Addictions Nurse Program Referral Form

September 19, 2022pdf162 KBchamplainformspdf
Negative Pressure Wound Therapy Prescription Form

Negative Pressure Wound Therapy Prescription Form

September 19, 2022pdf525 KBchamplainformspdf
Referral Form for Home and Community Care Services

Referral Form for Home and Community Care Services

September 19, 2022pdf639 KBchamplainformspdf
Regional Palliative Consultation Team Referral Form

Regional Palliative Consultation Team Referral Form

September 19, 2022pdf233 KBchamplainformspdf
Symptom Response Kit for End of Life Order Form

Symptom Response Kit for End of Life Order Form

September 19, 2022pdf258 KBchamplainformspdf
Telehomecare COVID-19 Remote Monitoring Referral Form – EN

Telehomecare COVID-19 Remote Monitoring Referral Form – EN

September 19, 2022pdf526 KBchamplainformspdf
Telehomecare COVID-19 Remote Monitoring Referral Form – FR

Telehomecare COVID-19 Remote Monitoring Referral Form – FR

September 19, 2022pdf381 KBchamplainformspdf
Telehomecare Remote Monitoring COPD HF Referral Form – EN

Telehomecare Remote Monitoring COPD HF Referral Form – EN

September 19, 2022pdf99 KBchamplainformspdf
TeleHomeCare Remote Monitoring Program Referral Form

November 29, 2022pdf827 KBchamplainformspdf
Telehomecare Remote Monitoring Program Referral Form-FR

November 29, 2022pdf1 MBchamplainformspdf
Telehomecare Remote Monitoring Referral Form – EN

Telehomecare Remote Monitoring Referral Form – EN

September 19, 2022pdf213 KBchamplainformspdf