Get Palliative Care Quick Access Medication Order Form

Completing the Palliative Care QUICK ACCESS Medication Order Form online is essential for ensuring the timely provision of medications to manage end-of-life symptoms. This guide offers you professional and supportive instructions to navigate the form effectively.

Follow the steps to fill out the form accurately online.

1. Press the ‘Get Form’ button to access the form online and open it in your designated editor.
2. Enter the patient name in the designated field, followed by their date of birth in the specified format (dd/mm/yy).
3. Fill in the patient’s Ontario Health Insurance Plan (OHIP) number, address, and phone number, ensuring that all information is accurate.
4. List any known allergies in the applicable field to ensure safety in medication ordering.
5. Indicate the medications needed for the patient by selecting from the provided list. Write your initials in the Initials column next to each medication you wish to include.
6. For medications marked with an asterisk (*) that are not covered under the Ontario Drug Benefits (ODB), call the Exceptional Access Coverage number to expedite processing.
7. If a Foley catheter is required, tick the specified box located near the medication table.
8. Complete the demographics section at the bottom of the page for the physician's information, including their signature, College of Physicians and Surgeons of Ontario (CPSO) number, phone number, fax number, and address.
9. Review all entered information for accuracy and completeness before submitting.
10. Fax the completed form to your chosen pharmacy and to Champlain CCAC; ensure you keep a copy for your records.

Complete your Palliative Care QUICK ACCESS Medication Order Form online today for streamlined medication management.