Palliative Care Information & Resources for Health Care Providers
Welcome to the Mississauga Health Palliative Care Resources section, designed specifically for health care providers in the Mississauga region. Here, you will find a comprehensive collection of referral forms, order forms, and bereavement packages to support you in delivering compassionate care. We aim to provide easy access to essential resources to help you navigate the palliative care process with efficiency and confidence. Please explore the materials below to assist in your practice and enhance the care you provide to your patients and their families.
Palliative Care Information & Resources for Health Care Providers
Welcome to the Mississauga Health Palliative Care Resources section, designed specifically for health care providers in the Mississauga region. Here, you will find a comprehensive collection of referral forms, order forms, and bereavement packages to support you in delivering compassionate care. We aim to provide easy access to essential resources to help you navigate the palliative care process with efficiency and confidence. Please explore the materials below to assist in your practice and enhance the care you provide to your patients and their families.
Referral Forms
Palliative Care Common Referral Form:
To be used to refer patients to any hospice within the province of Ontario. Locally this form is used to refer patients to our local hospices in addition to the Dorothy Ley Community Physician Group
Integrated Palliative Care Program Referral Form
Ontario Health at Home Palliative Referral Form
Trillium Health Partners Ambulatory Care Palliative Care Referral Form:
Referral Form to be used for those who ideally reside within the THP catchment area
Dorothy Ley Hospice Referral Forms
Community Hospice Referral Form: To be used for individuals who reside within the South Etobicoke catchment area requiring psychosocial, caregiver and/or grief/bereavement support
Hospice Residence and Community Physician Team Palliative Care Common Referral Form (See above Palliative Care Common Referral Form)
Physician Ambulatory Care Clinc Referral form: For individuals who are ambulatory and able to attend in-person clinics with DLH MD catchment areas.
Hospice Mississauga Referral Form:
For those individuals who reside within Mississauga seeking community hospice supports. This form can be used for all of Hospice Mississauga’s programs including HUUG and grief and bereavement.
Additional Forms
Expected Death in the Home (EDITH) Form:
Expected Death in the Home form is to be completed by the patients Care Coordinator and/or visiting nurse, as home care services MUST be in place. If you have an individual who has expressed their wish to remain at home for End of life, please ensure a referral is completed to OH atHome or the Integrated Palliative Care Program and request this form to be completed.
Do not Resuscitate (DNR-C) Request Form:
Complete for submit a Forms Order Request to request the mailing of official DNR-C Forms. Each DNR Form is unique to each individual and cannot be reused or photocopied for another patient. You can tell the DNR-C form is official by the red serial numbers located on the top right-hand corner.
Symptom Relief Kit (SRK) Order Form:
This is an MD/NP order that intended to facilitate timely access to a range of medications to address potential urgent symptom concerns that can arise in a patient’s home. The SRK is to be accessed by the visiting nurse. Once accessed the nurse is responsible in notifying the MRP/NP of the change in the patients’ condition and the medications that have been initiated to ensure ongoing medication orders are in place.
OHIP Payments for Palliative Care Services
Be Prepared:
Palliative Care Emergencies in the Home (6 different guides; SOB, Hypercalcemia, hemorrhage, seizures, spinal cord compression, SVC obstruction)
Education/ Resources
Ontario Palliative Care Network (OPCN)
The Ontario Palliative Care Network works to improve access to high-quality palliative care across Ontario. They provide resources, including a 3-step model of best practice tool kit to help support primary care providers with palliative care delivery.
CorHealth Ontario
CorHealth Ontario provides strategic leadership to improve cardiovascular health through evidence informed practice. They provide a wide range of resources for both patients/caregivers as well as health care providers. The resources linked here are to help with those diagnosed with heart failure.
Ontario Renal Network (ORN)
The Ontario Renal Network aims to empower and support patients and family members in taking an active role in their kidney care journey. They offer clinical resources for health care providers specific for patients living with chronic kidney disease who would benefit from a palliative care approach. Learn more at ORN [Clinical Tools & Education | ORN]Cancer Care Ontario Symptom Management Guidelines
Cancer Care Ontario (CCO)
Cancer Care Ontario offers resources for managing cancer-related symptoms and side effects, providing both health care professionals and patients with tools and information. It covers a range of symptoms such as pain, fatigue, nausea, anxiety, and more, offering guidance on home management and when to seek medical advice. Whether you’re a patient or a caregiver, these resources help maintain well-being throughout the cancer treatment journey.
Canadian Home Care Association (CHCA)
Canadian Home Care Association has developed tools and resources that support frontline workers in adopting the Palliative Care Competency Framework with the use of emotional intelligence (EI) tools. They offer a variety of resources including practice aids and conversation guides specifically for palliative care emergencies in the home.
Pallium Canada
Pallium is a national organization that focuses on building professional and community capacity to help improve access to quality palliative care. Visit their website to learn more and register for the accredited palliative courses including Learning Essentials of Palliative Care (LEAP) and the Canadian Serious Illness Conversation Course (CSIC).
Project ECHO
Supported by Pallium Canada, Project ECHO supports continuous learning opportunities for all health care professionals.
Hospice Palliative Care Ontario (HPCO)
Hospice Palliative Care Ontario (HPCO) is a provincial association that supports in informing policy and promoting awareness, knowledge and education across Ontario. They have a number of educational resources available for caregivers and health care providers. Some courses that they have available speak to Person-Centred Decision Making and Palliative Care Education for Personal Support Workers (PSWs).
Acclaim Health
Acclaim offers a number of introductory and advanced level courses and workshops for all health care professionals. Some examples of courses that they offer included Fundamentals of Hospice Palliative Care and Pain Assessment and Management.