Erie St. Clair
Information and Referral
310-2222
Toll-free:1-888-447-4468
TTY:519-258-8092
esc.engagement@hccontario.ca
IMPORTANT: DO NOT send any personal health information. This email is not for patient feedback or referrals. Please call us directly at the numbers listed above. We aim to respond within 72 hours, however, this email account is not checked on weekends or statutory holidays.
IMPORTANT: DO NOT send any personal health information. This email is not for patient feedback or referrals. Please call us directly at the numbers listed above. We aim to respond within 72 hours, however, this email account is not checked on weekends or statutory holidays.
Visit Erie St. Clair Healthline
Erie St. Clair Office Locations
-
Chatham (Corporate Office)
180 Riverview Drive,
Chatham, ON, N7M 5Z8
Fax: Chatham-Kent – 519-351-5842 -
Chatham Clinic
462 Riverview Drive
Chatham, ON, N7M 0N2
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Sarnia Office & Clinic
1150 Pontiac Drive,
Sarnia, ON, N7S 3A7
Fax: Sarnia-Lambton: 519-337-4331 -
Windsor Office & Clinic
5415 Tecumseh Road, East,
Windsor, ON, N8T 1C5
Fax: Windsor-Essex: 519-258-6288
Compliments and Concerns?
Please share your feedback with your care coordinator. You may also share compliments or concerns in the following ways:
Email: jenna.martin@hccontario.ca
Phone: 1-888-447-4468 ext. 5378
Mail: Home and Community Care Support Erie St. Clair Compliments and Concerns
Attn: Patient Relations Specialist
180 Riverview Drive
Chatham, ON N7M 5Z8
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.
Publications
Forms
| Title | Summary | Region | Last Modified | Category | File Type | File Size | Link | hf:doc_tags | hf:doc_categories | hf:file_type |
|---|---|---|---|---|---|---|---|---|---|---|
| Assessment & Service Plan Authorization Private/In-Home School | Assessment service plan form – fillable | Erie St. Clair | June 26, 2023 | Forms | 835 KB | erie-st-clair | forms | |||
| BWH-ER Referral and Treatment Form | Bluewater Water Health emergency referral and treatment form – fillable | Erie St. Clair | June 27, 2023 | Forms | 1 MB | erie-st-clair | forms | |||
| BWH-Inpatient Referral and Treatment Form | Bluewater Water Health inpatient referral and treatment form – fillable | Erie St. Clair | June 26, 2023 | Forms | 2 MB | erie-st-clair | forms | |||
| BWH-Outpatient Referral and Treatment Form | Bluewater Water Health outpatient referral and treatment form – fillable | Erie St. Clair | June 27, 2023 | Forms | 1 MB | erie-st-clair | forms | |||
| CHSS Referral Form Public Private | Children’s Health School Services Program referral form – fillable | Erie St. Clair | June 26, 2023 | Forms | 1 MB | erie-st-clair | forms | |||
| CHSS Referral Form Public Private French | Children’s Health School Services Program referral form – fillable, French | Erie St. Clair | June 26, 2023 | Forms | 129 KB | erie-st-clair | forms | |||
| CKHA-ER Referral and Treatment Plan Form | Chatham-Kent Health Alliance emergency referral and treatment form – fillable | Erie St. Clair | June 27, 2023 | Forms | 1 MB | erie-st-clair | forms | |||
| CKHA-Inpatient Referral and Treatment Plan Form | Chatham-Kent Health Alliance inpatient referral and treatment form – fillable | Erie St. Clair | June 26, 2023 | Forms | 1 MB | erie-st-clair | forms | |||
| CKHA-Outpatient Referral and Treatment Form | Chatham-Kent Health Alliance outpatient referral and treatment form – fillable | Erie St. Clair | June 27, 2023 | Forms | 1 MB | erie-st-clair | forms | |||
| Electrical Stimulation (eSTIM) Non-Formulary Order Form | Electrical Stimulation (eSTIM) non-formulary order form – fillable | Erie St. Clair | June 26, 2023 | Forms | 700 KB | erie-st-clair | forms | |||
| Electrical Stimulation (eSTIM) Referral Assessment | Electrical Stimulation (eSTIM) referral assessment form – fillable | Erie St. Clair | June 26, 2023 | Forms | 383 KB | erie-st-clair | forms | |||
| Equipment Rental Authorization Order Form | Equipment rental authorization/order form – fillable | Erie St. Clair | June 26, 2023 | Forms | 221 KB | erie-st-clair | forms | |||
| ESHC-ER Referral and Treatment Form | Erie Shores HealthCare emergency referral and treatment form – fillable | Erie St. Clair | June 27, 2023 | Forms | 1 MB | erie-st-clair | forms | |||
| ESHC-Inpatient Referral and Treatment Form | Erie Shores HealthCare inpatient referral and treatment form – fillable | Erie St. Clair | July 4, 2023 | Forms | 1 MB | erie-st-clair | forms | |||
| ESHC-Outpatient Referral and Treatment Form | Erie Shores HealthCare outpatient referral and treatment form – fillable | Erie St. Clair | June 27, 2023 | Forms | 1 MB | erie-st-clair | forms | |||
| Feeding Respiratory Suction Med. Equipment & Supplies Order Form | … | Erie St. Clair | September 16, 2022 | Forms | 826 KB | erie-st-clair | forms | |||
| First Dose Parenteral Screener (ESC) | First dose parenteral screener form – fillable | Erie St. Clair | June 21, 2023 | Forms | 514 KB | erie-st-clair | forms | |||
| geko Device Eligibility Checklist & Assessment Tool | … | Erie St. Clair | September 16, 2022 | Forms | 826 KB | erie-st-clair | forms | |||
| Guidelines for Provision of KCI VAC NPWT | Guidelines for provision of KCI VAC negative pressure wound therapy | Erie St. Clair | July 4, 2023 | Forms, Guide | 424 KB | erie-st-clair | forms guide | |||
| HDGH-Inpatient Referral and Treatment Form | Hôtel-Dieu Grace Healthcare inpatient referral and treatment form – fillable | Erie St. Clair | July 4, 2023 | Forms | 1 MB | erie-st-clair | forms | |||
| Medical Supply Order Form | … | Erie St. Clair | September 16, 2022 | Forms | 1 MB | erie-st-clair | forms | |||
| Medical Update Request Form | Medical update request form | Erie St. Clair | July 4, 2023 | Forms | 1 MB | erie-st-clair | forms | |||
| Medical Update Request Form – Wound | Medical update request form – wound | Erie St. Clair | July 4, 2023 | Forms | 1 MB | erie-st-clair | forms | |||
| MHAN e-Referral Form | Mental Health and Addictions Nursing Program Referral Form for School Board, Community Agencies, etc. | Erie St. Clair | May 31, 2023 | Forms | html | erie-st-clair | forms | html | ||
| MHAN Self-Referral Form | Mental Health and Addictions Nursing Program Self Referral Form | Erie St. Clair | May 31, 2023 | Forms | html | erie-st-clair | forms | html | ||
| Negative Pressure Wound Therapy | Negative pressure wound therapy supply order form – fillable | Erie St. Clair | July 5, 2023 | Forms | 208 KB | erie-st-clair | forms | |||
| Negative Pressure Wound Therapy – Referral Assessment | Negative pressure wound therapy referral assessment form – fillable | Erie St. Clair | July 5, 2023 | Forms | 5 MB | erie-st-clair | forms | |||
| Non-formulary Medical Equipment Order Form | Non-formulary medical equipment order form – fillable | Erie St. Clair | July 5, 2023 | Forms | 713 KB | erie-st-clair | forms | |||
| Non-formulary Medical Supplies Order Form | Non-formulary medical supplies order form – fillable | Erie St. Clair | July 5, 2023 | Forms | 96 KB | erie-st-clair | forms | |||
| Offloading Shoe Assessment Form | Offloading assessment form – fillable | Erie St. Clair | July 5, 2023 | Forms | 359 KB | erie-st-clair | forms | |||
| Ostomy Consultation Report | … | Erie St. Clair | September 16, 2022 | Forms | 270 KB | erie-st-clair | forms | |||
| Ostomy Supply Order Form | Ostomy supply order form – fillable | Erie St. Clair | August 29, 2023 | Forms | 270 KB | erie-st-clair | forms | |||
| Providers Cupboard Usage | Providers cupboard usage order form – fillable | Erie St. Clair | July 5, 2023 | Forms | 396 KB | erie-st-clair | forms | |||
| Referral and Treatment Form | Referral and treatment plan form – fillable | Erie St. Clair | June 27, 2023 | Forms | 1 MB | erie-st-clair | forms | |||
| Referral and Treatment Form – Pain Medication | Referral and treatment plan pain medication order form – fillable | Erie St. Clair | July 6, 2023 | Forms | 795 KB | erie-st-clair | forms | |||
| Replenishment Order Form – Nursing | Replenishment order form nursing – fillable | Erie St. Clair | July 6, 2023 | Forms | 187 KB | erie-st-clair | forms | |||
| Replenishment Order Form – WCS | Replenishment order form WCS – fillable | Erie St. Clair | July 6, 2023 | Forms | 178 KB | erie-st-clair | forms | |||
| Telehomecare Referral Form | Telehomecare referral form – fillable | Erie St. Clair | July 6, 2023 | Forms | 639 KB | erie-st-clair | forms | |||
| Total Contact Casting Treatment and Assessment | Total contact casting treatment and assessment forms – fillable | Erie St. Clair | August 16, 2023 | Forms | 968 KB | erie-st-clair | forms | |||
| Walker Assessment Form | Walker assessment eligibility form | Erie St. Clair | July 6, 2023 | Forms | 132 KB | erie-st-clair | forms | |||
| WRH – Ouellette – ER – First Dose (ESC) | … | Erie St. Clair | May 2, 2023 | Forms | 679 KB | erie-st-clair | forms | |||
| WRH Met Outpatient Referral and Treatment Form | Windsor Regional Hospital – Met Campus out patient referral and treatment form – fillable | Erie St. Clair | June 27, 2023 | Forms | 1 MB | erie-st-clair | forms | |||
| WRH-Met-ER Referral and Treatment Form | Windsor Regional Hospital – Met Campus emergency referral and treatment form – fillable | Erie St. Clair | July 6, 2023 | Forms | 1 MB | erie-st-clair | forms | |||
| WRH-Met-Inpatient Referral and Treatment Form | … | Erie St. Clair | September 16, 2022 | Forms | 1 MB | erie-st-clair | forms | |||
| WRH-Met-Outpatient URO Referral and Treatment Form | Windsor Regional Hospital – Met Campus outpatient URO referral and treatment form – fillable | Erie St. Clair | June 27, 2023 | Forms | 1 MB | erie-st-clair | forms | |||
| WRH-Ouellette-ER Referral and Treatment Form | … | Erie St. Clair | June 27, 2023 | Forms | 1 MB | erie-st-clair | forms | |||
| WRH-Ouellette-Inpatient Referral and Treatment Form | … | Erie St. Clair | September 16, 2022 | Forms | 1 MB | erie-st-clair | forms | |||
| WRH-Ouellette-Outpatient Referral and Treatment Form | Windsor Regional Hospital – Ouellette Campus outpatient referral and treatment form – fillable | Erie St. Clair | June 27, 2023 | Forms | 1 MB | erie-st-clair | forms |