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Displaying 1 - 10 of 41.

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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...

Diabetes Referral Form

https://www.princeedwardisland.ca/sites/default/files/forms/diabetes_referral_form.pdf
2016-10-26
Complete this form to refer or self-refer to the Provincial Diabetes Program or the Diabetes Drug Program .
Referral Provincial Diabetes Program and Diabetes Drug Program Refer to: 9 Provincial Diabetes Program Q Diabetes Drug program (Pharmacare) (check all that apply) Reason for referral: Q New diagnosis Q Re-referral Q Change of treatment Q Insulin...

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:...

Health Research Ethics Board: Confirmation of Supervisor's Review

https://www.princeedwardisland.ca/sites/default/files/forms/reb_confirmation_of_supervisors_review.pdf
2016-03-22
Health Research Ethics Board requires and student/trainee conducting research with human participants have their supervisor complete this form
Version 1, Dated April 2015 PEI Research Ethics Board Confirmation of Supervisor’s Review To be completed for Graduate, Honours and other Trainee research submissions All trainees who are conducting human participant research...

Hillsborough Hospital Volunteer Services Application Form

https://www.princeedwardisland.ca/sites/default/files/forms/hillsborough_hospital_volunteer_application_form.pdf
2016-03-16
Complete and submit the Hillsborough Hospital Volunteer Services Application Form to volunteer at Hillsborough Hospital.
C:\Documents and Settings\gemacdonald\Local Settings\Temp\Volunteer Application Form Final.wpd VOLUNTEER SERVICES Hillsborough Hospital PO Box 1929 Charlottetown, PE C1A 7N5 Phone: 368-5466 NAME...

QEH Volunteer Services Application Form

https://www.princeedwardisland.ca/sites/default/files/forms/qeh_volunteer_services_application_form.pdf
2016-03-16
Complete this form to apply to volunteer at Queen Elizabeth Hospital.
QEH Volunteer Services Application Form APPLICATION FORM - VOLUNTEER SERVICES QUEEN ELIZABETH HOSPITAL - CHARLOTTETOW N, P.E.I. NAME DATE OF BIRTH (dd/mm/yy) HOME PHONE NO. ADDRESS POSTAL CODE CELL PHONE NO. EMAIL ADDRESS EMPLOYER SCHOOL/...
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