Referrals

We accept referrals from physicians

  • Please use our REFERRAL FORM
  • Please note we cover a certain geographic range by postal code (see coverage area here)
  • Explain reason for the referral (symptoms, end of life care)
  • Attach necessary documents such as recent oncology notes, imaging and lab values (we do not have access to OACIS)
  • Have sufficient demographics for the patient
  • We require a contact fax and phone number for the referring physician
  • The referring physician remains most responsible physician until the first visit by a CPG physician
  • We often have a wait list, more information helps us to triage
  • At times where we have wait list our acceptance criteria may become more restrictive
  • We always focus on assisting people who are at the end of life and wish to remain at home

Patient details

  • An adult patient with a life-limiting illness with an expected prognosis of 6 months or less
  • Is aware of their diagnosis and prognosis
  • Is aware the referral has been made
  • Wants to be cared for at home and to have a home or hospice death
  • A patient who is DNR
  • The patient has reduced functionality: mainly in bed, or sitting, and needs help for ADLs
  • The patient wishes palliative goal of care and the family agrees to these goals. Generally this means accepting only treatments available in the community but does not exclude returning to hospital for treatments such as palliative radiation, etc.
  • Has Champlain LHIN (previously CCAC) palliative case manager and a chart in the home
  • Has adequate 24/7 support in the home to allow a home death or wishes transfer to hospice
  • The patient's family physician, or retirement home physician, has been contacted, and agrees with the referral
  • The referring physician and the patient are aware that until the initial visit by a CPG physician, the referring physician will continue to be the most responsible physician