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Displaying 1 - 10 of 13.

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Goals of Care Form

https://www.princeedwardisland.ca/sites/default/files/forms/goals_of_care_form.pdf
2016-11-23
The Goals of Care form is used by your health care provider after speaking with you and your substitute decision maker. These instructions that will guide your health care team about the general focus of your care and where you might want that care. Your health care provider will write your Goals...
Microsoft Word - Goals of Care Form.docx GOALS OF CARE Is there an existing Health Care Directive on file? No Yes (If yes, it shall guide further discussions as an indication of the Patient/Client/Resident’s wishes at time...

Blood Glucose Record - Travelling Across Time Zones

https://www.princeedwardisland.ca/sites/default/files/forms/blood_glucose_record_-_across_time_zones.pdf
2016-04-21
Use this to record your blood glucose levels while you are travelling across time zones.
H:\Martha's Files\Provinical Diabetes Program\Provincial Team Meeting\website design\FAQ section\Diabetes and Traveling Across Diabetes and Traveling Across Time Zones Leaving Insulin Food Returning Insulin Food West: Usual dose + (...

Blood Glucose Record - 24 Hour

https://www.princeedwardisland.ca/sites/default/files/forms/blood_glucose_record_-_24_hour.pdf
2016-04-21
Use this to record your blood glucose levels over a 24 hour period.
24 Hour Blood Glucose Record Patient Name:_______________________________________________________________________________________________ Phone: _______________________________________Email:_______________________________________ Day/ Date ____ 12AM...

Blood Glucose Record

https://www.princeedwardisland.ca/sites/default/files/forms/blood_glucose_record.pdf
2016-04-21
Use this to record your blood glucose levels.
C:\Documents and Settings\wematthews\Desktop\Martha\Insulin BG Monitoring.wpd Home Blood Glucose Monitoring Provincial Diabetes Program January 2009 Name:   Phone:   Insulin Dose...

Paediatric Speech and Language Pathology Case History Form

https://www.princeedwardisland.ca/sites/default/files/forms/paediatric_speech_language_case_history_form.pdf
2016-03-30
Case history for your child to be completed and returned to Speech Language Pathology before your initial appointment.
Speech Language Pathology 161 St. Peter’s Road PO Box 2000 Charlottetown, PE C1A 7N8 T: 1-844-344-TALK (8255) / F:902-620-3195 speechandhearing@ihis.org Orthophonie 161, chemin St. Peter’s C.P. 2000, Charlottetown Île-du-Prince-...

Adult Speech and Language Pathology Case History Form

https://www.princeedwardisland.ca/sites/default/files/forms/adult_speech_language_case_history_form.pdf
2016-03-30
Case history to be completed before your initial visit to Speech Language Pathology
Please use additional paper if required to provide detailed information. Adult Speech and Language Pathology Case History Name:...

FIT Home Screening Test Request Form

https://www.princeedwardisland.ca/sites/default/files/forms/fit_home_screening_test_request_form.pdf
2016-03-03
Complete this FIT Home Screening Test Request form if you are, 50-74 years of age, and are of, average risk for colorectal cancer, . 
Microsoft Word - FIT June 2015_1.docx FIT Home Screening Test Request Form Thank you for your interest in a home screening test. The PEI Colorectal Cancer Screening Program is for Islanders aged 50-74 years of age who are of average risk for...

Adult Audiology Case History Form

https://www.princeedwardisland.ca/sites/default/files/forms/adult_audiology_case_history.pdf
2016-01-07
Complete this form to provide information on your hearing and submit with your Audlt Audiology Referral Form.
Audiology 161 St. Peter’s Road PO Box 2000 Charlottetown, PE C1A 7N8 T: 902-368-5807 / F:902-620-3195 Email: speechandhearing@ihis.org Audiologie 161, chemin St. Peter’s C.P. 2000, Charlottetown...

Child Audiology Case History Form

https://www.princeedwardisland.ca/sites/default/files/forms/child_audiology_case_history.pdf
2016-01-07
Complete this form to provide information on your child's hearing and submit with your Child Audiology Referral Form.
Audiology 161 St. Peter’s Road PO Box 2000 Charlottetown, PE C1A 7N8 T: 902-368-5807 / F:902-620-3195 Audiologie 161, chemin St. Peter’s C.P. 2000, Charlottetown Île-du-Prince-Édouard, C1A...

Eye See...Eye Learn Co-pay Reimbursement Application

https://www.princeedwardisland.ca/sites/default/files/forms/eye_see_eye_learn_copay_reimbursement_application.pdf
2016-01-07
Complete and submit an application for co-pay reimbursement for the Eye See... Eye Learn program if your optometrist is unable to bill your insurance provider directly.  You will have to pay up front and be reimbursed for the remaining amount.  
DRAFT PEI Eye See Eye Learn Program Application for Co-Pay Reimbursement Public Health & Children’s Developmental Services Speech Language Pathology, Audiology and Eye See Eye Learn Programs 161 St. Peters Road PO Box 2000 Charlottetown, PE C1A 7N8...
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