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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 .
PATIENT REGISTRATION FORM DIABETES DRUG PROGRAM Fax requests to (902) 368-4905 OR mail requests to PEI Pharmacare, P.O. Box 2000,...

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...

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...

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...

Ankylosing Spondylitis Special Authorization Request Form

https://www.princeedwardisland.ca/sites/default/files/forms/ankylosing_spondylitis_special_authorization_request_form.pdf
2016-03-02
Special authorization request form to be completed by your physician or diagnosing specialist.
SPECIAL AUTHORIZATION REQUEST ANKYLOSING SPONDYLITIS Fax requests to (902) 368-4905 OR mail requests to PEI...

DPP-4 / SGLT2 Inhibitors Special Authorization Request Form

https://www.princeedwardisland.ca/sites/default/files/forms/dpp-4_sglt2_inhibitors_special_authorization_request_form.pdf
2016-03-02
Special authorization request form to be completed by your physician or diagnosing specialist.
SPECIAL AUTHORIZATION REQUEST DPP-4/SGLT2 INHIBITORS Fax requests to (902) 368-4905 OR mail requests to PEI Pharmacare...

Enfuvirtide Special Authorization Request Form

https://www.princeedwardisland.ca/sites/default/files/forms/enfuvirtide_special_authorization_request_form.pdf
2016-03-02
Special authorization request form to be completed by your physician or diagnosing specialist.
FORMS WITH INFORMATION MISSING WILL BE RETURNED FOR COMPLETION. APPROVALS WILL NOT BE CONSIDERED AT DOSES OR DOSING INTERVALS OUTSIDE OF PEI GUIDELINES. SPECIAL AUTHORIZATION REQUEST ENFUVIRTIDE (FUZEON) Fax requests to (902) 368-4905 OR mail...

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