Microsoft Word - 2016.Nov.EMTLicense17-19.VerificationOfRegistration.docx
Personal information on this form is collected by the EMS Board under the authority of the Prince Edward Island’s Emergency Medical Technicians Act and Emergency Medical...
Influenza Immunization Clinic
Registration Form 2017/2018
Gender: Male ☐ Female ☐
Part 1: To be completed by Admin Support
□ 6 - 59 months Date:
□ 65 + Clinic...
C:\Documents and Settings\gemacdonald\Local Settings\Temp\oop travel accomm assistance Health PEI version.wpd
Medical Affairs Affaires médicales
16 Garfield Street 16, rue Garfield
PO Box 2000, Charlottetown...
Microsoft Word - 12HE15-34192ImmunizationConsent.docx
Immunization Consent Form
Name: ___________________ Personal Health Number: __________________DOB: ________________
Immunization can prevent many communicable diseases. It is...
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...
Application for Release of Information for Research Purposes
Personal information on this form is collected under the Pharmaceutical Information Act and Regulations. This information is required
in order to process your application for...