Hamilton Niagara Haldimand Brant

Information and Referral

Toll Free: 1-800-810-0000

Fax: 1-866-655-6402 (for patient-related information and referrals)
TTY:711
Email:access@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.

Connect with Your Regional Healthline

Hamilton Niagara Haldimand Brant Local Offices

  • Hamilton (Corporate Office)
    211 Pritchard Road,
    Unit 1,
    Hamilton, ON, L8J 0G5
  • Niagara
    149 Hartzel Road,
    St. Catharines, ON, L2P 1N6
  • Haldimand-Norfolk
    76 Victoria Street,
    Simcoe, ON, N3Y 1L5
  • Brant
    195 Henry Street,
    Unit 4, Building 4,
    Brantford, ON, N3S 5C9
  • Burlington
    440 Elizabeth Street,
    4th Floor,
    Burlington, ON, L7R 2M1

Compliments and Concerns?

Please share your feedback with your care coordinator. You may also share compliments or concerns in the following ways:

Email: hnhb.patientrelations@hccontario.ca

Phone: 1-866-790-4642 ext. 3883

Mail: Attention – Manager, Patient Relations
211 Pritchard Road, Unit 1, Hamilton ON  L8J 0G5

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
Brant (use the Hospice Referral Form and order Outreach Services)

September 20, 2022pdf2 MBhamilton-niagara-haldimand-brantformspdf
Burlington PCOT

September 20, 2022pdf1 MBhamilton-niagara-haldimand-brantformspdf
Ceftriaxone Protocol Medical Referral Form

To order the administration of ceftriaxone to patients being discharged from the Brantford Community Healthcare System (BCHS)

September 20, 2022pdf1 MBhamilton-niagara-haldimand-brantformspdf
Community Paramedicine High Intensity LTC Communication Form

September 28, 2022pdf623 KBhamilton-niagara-haldimand-brantformspdf
Complex Care Expedited Admission Form

To notify us of a patient’s admission to a complex care bed before an application could be completed

September 20, 2022pdf1 MBhamilton-niagara-haldimand-brantformspdf
Complex Care Rehabilitation Application Form

Completed with the patient as an application to one of the complex care streams: short-term or long-term medically complex, activation and restoration, end of life or behavioural; low intensity rehab or high intensity rehab

September 20, 2022pdf2 MBhamilton-niagara-haldimand-brantformspdf
First Dose – IV Medications Form

To order first dose IV medications to be administered to patients in the community

September 20, 2022pdf996 KBhamilton-niagara-haldimand-brantformspdf
Haldimand PCOT

September 20, 2022pdf1 MBhamilton-niagara-haldimand-brantformspdf
Hamilton – PCOT Referral Form

November 30, 2022pdf2 MBhamilton-niagara-haldimand-brantformspdf
Hamilton PCOT Referral Form

November 30, 2022pdf2 MBhamilton-niagara-haldimand-brantformspdf
HNHB Medical Supplies Catalogue

To order from HNHB’s medical supplies catalogue

October 18, 2022pdf708 KBhamilton-niagara-haldimand-brantformspdf
HNHB Referral Form – EN

Complete the Request for Home and Community Care Support Services HNHB form and fax it to the appropriate location. Refer to page 2 of the form for fax numbers.

Primary Care Partners: in addition to using the form above, you may also connect directly with the Care Coordinator aligned with your office/practice.

October 18, 2022pdf1 MBhamilton-niagara-haldimand-brantformspdf
Home Parenteral Nutrition Medical Order Form – Pediatric at McMaster Children’s Hospital

To order care relating to the Protocol for Home Parenteral Nutrition (PPN or TPN) for pediatric patients at McMaster Children’s Hospital

October 5, 2022pdf2 MBhamilton-niagara-haldimand-brantformspdf
Hospice Referral Form

To refer a patient to (apply for) hospice and hospice-type services

September 20, 2022pdf2 MBhamilton-niagara-haldimand-brantformspdf
HPG User Access Authorization Form

For hospital partners who use Health Partner Gateway to receive patient referrals.

September 20, 2022pdf1 MBhamilton-niagara-haldimand-brantformspdf
Influenza Vaccine Form

To order administration of influenza vaccine

September 20, 2022pdf1 MBhamilton-niagara-haldimand-brantformspdf
Iron Infusion Form

To order intravenous iron replacement

September 19, 2022pdf2 MBhamilton-niagara-haldimand-brantformspdf
Letter of Understanding – Pronouncement and Certification Death

To identify who will complete pronouncement and certification of death for an expected death at home

September 20, 2022pdf1 MBhamilton-niagara-haldimand-brantformspdf
Medical Assistance in Dying Medical Order Form

To order nursing and IV starts for MAiD

September 20, 2022pdf1 MBhamilton-niagara-haldimand-brantformspdf
Medical Order Form – General

To order general medications, including wound care and maintenance for urinary catheters

September 20, 2022pdf1 MBhamilton-niagara-haldimand-brantformspdf
Medical Supplies Catalogue

September 20, 2022pdf708 KBhamilton-niagara-haldimand-brantformspdf
Mental Health Addictions Nurse Referral Form

To request the services of the Mental Health & Additions Nurse, the patient must be:

1. A student registered in school and who is no older than 21 years of age (may include home instruction)
2. In need of services or related treatment to an identified and/or suspected mental health and/or addictions issue
3. Aware of and consenting to the referral

Additionally, there must be a clearly defined role for the Mental Health & Addictions Nurse

September 20, 2022pdf1 MBhamilton-niagara-haldimand-brantformspdf
Midline Catheter Form

To order midline catheter maintenance

September 20, 2022pdf2 MBhamilton-niagara-haldimand-brantformspdf
Negative Pressure Wound Therapy Form

To request negative pressure wound therapy for pressure ulcers, diabetic foot ulcers, arterial ulcers, venous ulcers and surgical wounds

September 20, 2022pdf2 MBhamilton-niagara-haldimand-brantformspdf
Negative Pressure Wound Therapy Special Circumstance Form

To request negative pressure wound therapy for patients with special circumstances, e.g. patient has had a wide excision with skin graft or an STSG greater than 2 cm squared

September 20, 2022pdf1 MBhamilton-niagara-haldimand-brantformspdf
Niagara PCOT Referral Form

November 30, 2022pdf1 MBhamilton-niagara-haldimand-brantformspdf
Nursing Care Centre – Information Handout HNHB

November 2, 2022pdf490 KBhamilton-niagara-haldimand-brantformspdf
Palliative Symptom Response Form

For the management of rapid-onset, unanticipated symptoms for patients nearing end–of-life and no longer able to swallow oral medications. The medication on this order form is limited to support short duration of symptom management (48 hours) until further medications are ordered.

September 20, 2022pdf993 KBhamilton-niagara-haldimand-brantformspdf
Palliative Symptom Response Guideline

October 5, 2022pdf3 MBhamilton-niagara-haldimand-brantformspdf
Patient and Family Information about Palliative Symptom Response Medication

September 28, 2022, pdf334 KBhamilton-niagara-haldimand-brantforms information-sheetpdf
Plan of CPR Treatment Form – Palliative Care

To clearly communicate a patient’s plan of care relating to the provision of CPR.

September 20, 2022pdf733 KBhamilton-niagara-haldimand-brantformspdf
Protocol for Central Vascular Access Devices – Pediatrics

To order care relating to vascular access devices in children

September 20, 2022pdf2 MBhamilton-niagara-haldimand-brantformspdf
Protocol for Vascular Access Devices Medical Order Form

To order care relating to vascular access devices in adults (in accordance with the Vascular Access Maintenance Protocol)

September 20, 2022pdf1,014 KBhamilton-niagara-haldimand-brantformspdf
Protocol Parenteral Nutrition Medical Order Form- Adult Population

To order care relating to the Protocol for Home Parenteral Nutrition (PPN or TPN) for adult patients

September 20, 2022pdf1 MBhamilton-niagara-haldimand-brantformspdf
Respiratory Therapy Referral Form

For patients being discharged home from hospital with a new tracheostomy and laryngectomy care for patients being discharged home from hospital

September 20, 2022pdf1 MBhamilton-niagara-haldimand-brantformspdf
Vancomycin Aminoglycoside Prescription Form

To order IV vancomycin and/or aminoglycosides for patients in the community

September 20, 2022pdf812 KBhamilton-niagara-haldimand-brantformspdf