№ files_lp_4_process_3_110646
Clinical referral and admission form used by Michael Garron Hospital Ventilation and Weaning Programs to document patient identification, clinical history, ventilatory support status, functional condition, and social context for evaluation of long-term mechanical ventilation care.
Year: Not specified
Country: Canada
City: Toronto, ON
Institution: Michael Garron Hospital
Department / Program: Ventilation and Weaning Programs
Address: 825 Coxwell Ave E, Toronto, ON, M4C 3E7
Organization: Toronto East Health Network
Document type: Medical program admission application form
Subject: Long-term mechanical ventilation and ventilator weaning care
Primary users: Referring physicians and hospital staff
Patient information fields: Identification, contact information, substitute decision maker, power of attorney for finances
Clinical information fields: Admission diagnoses, past medical history, surgical history, psychiatric history, medications and allergies
Respiratory care data: Tracheostomy details, mechanical ventilation settings, diaphragm pacer status
Functional assessment sections: Cognition, mood, behaviour, nursing care, communication abilities, swallowing and diet, occupational therapy, mobility and equipment
Social information: Family situation and caregiving involvement
Decision-making information: Goals of care, prognosis discussion with patient or substitute decision maker
Required authorization: Physician signature and contact information
Program contact: Prolonged Ventilation Program, Michael Garron Hospital
Program director: Marcus J. Kargel MD FRCPC FCCP
Program manager: Karen Kerry
Price: 8 / 10 USD
The file will be delivered to the email address provided at checkout within 12 hours.

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