Providing Palliative Pain & Symptom Management Consultations
A key role of our Hospice Palliative Care (HPC) Teams for the Central Local Health Integration Network (LHIN) is to provide palliative pain and symptom management consultations to patients, their caregivers and families, as well as primary care physicians, primary nurses and other service providers.
Our Clinical Nurse Consultants (CNCs) visit and have telephone consultations with referred patients and their caregivers/families to provide advice and support about helping their loved one manage palliative pain and symptoms.
To learn more about how we support healthcare providers,
visit: Palliative Consultations
Referring a Family Member or Friend
Patients, caregivers/family members, friends, physicians, nurses, community agencies, hospices, hospitals, long-term care and retirement homes can all refer someone for palliative pain and symptom management consultation. The referer will then serve as the point of contact for the individual referred.
Please note: The referred individual or their substitute decision-maker must be aware of the reason for the consultation referral and give their explicit consent to it.
To refer a family member or friend, select, download and complete the appropriate form below:
- If the individual is or has been a Southlake Health Centre or SRCC at Southlake patient, use this HPC Teams for Central LHIN Referral Form
- If the individual has not been a Southlake or SRCC at Southlake patient, use this Palliative Care – Common Referral Form (PC-CRF)
- If the individual is a long-term care resident, use this Long-Term Care Referral Form to HPC Teams
Complete the form as thoroughly as possible with the most current information or updated information. Include or attach consultative notes, medication lists, test and imaging results and other reports (dated within the last two weeks and current at time of referral).
If you have previously submitted either referral form and want to refer the individual for another service or need to update information, complete a PC-CRF Update/Report Form.
Fax the completed form, with any required documents, to 905-830-5978. Alternatively, you may mail the form and documents to: HPC Teams for Central LHIN, 596 Davis Drive, Box 22, Newmarket, Ontario L3Y 2P9
If you have any questions about this service or how to complete these forms, contact the HPC Teams at 905-830-5800 and follow the prompts.
