DATE     _________

CAMPUS___________       WARD________         FAX  613- _____________              

PATIENT__________________________                   DOB________________

This patient is from Nunavut and has special needs on discharge.
This discharge must to be coordinated with the Ottawa/ Baffin Program.

Please follow the check list below:
 

• As soon as a discharge is planned, call the Nursing Case Manager at 613-523-3202 or 613-523-8745 to advise us of pending discharge and to discuss any special needs.   This includes a patient who has died as the Case Manager needs to make “travelâ€? arrangements with the funeral home. After business hours or on weekends- page 613-788-1432.
• For Hospital to Hospital discharges, call the Case Manager ASAP at 613-523-3202 or 613-523-8745.  The manager will coordinate this process.
• Please dictate STAT discharge summary prior to the patient’s discharge. Call 1-9252 and tell them you have Baffin discharge and the dictation will be done in time for discharge.    Ward clerk, please, fax this discharge summary note to the Case Manager at 613-523-8163. 
• Fax any OT/ Physio/ Home Care referrals, follow-up appointments, medication, oxygen and/or equipment scripts to 613-523-8163.
  
  Note:   On the script include all medications including OTC drugs as the patient is covered under the NIHB program. 
  
  Note:   Some drugs, and most equipment, need special approval. This can take several days to obtain.
  
  Note:   Please be sure to print your name and your billing number on each script or there will be unnecessary delays.