Two ways to refer:

Physician Referral Form  – complete and fax

Ocean Healthmap – refer online via Ocean

Referral Criteria:

1. Patient has a life-limiting illness and is not planning to receive further curative treatment
2. Patient’s Palliative Performance Scale score is as follows: 40% or below for most malignant disease; 30% or below for end-stage chronic disease (e.g COPD, CRD, CHF)
3. Referring physician must seek consent from patient’s family doctor to pursue the referral, and have concluded that the family doctor cannot or does not wish to follow for end of life care
4. Home care services through the LHIN must be in place

Fax the completed referral to (343) 888-8889. It will then be triaged accordingly.