Airvo™ 2 Unit – Requesting Hospital Agreement
2021 | Forms
The Requesting Hospital is required to complete this form and submit as instructed before the release of an Airvo™ 2 Unit from the Provincial Stockpile
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Airvo™ 2 Unit Host Hospital Checklist for Sending and Receiving Provincial Airvo™ 2 Devices
2021 | Forms
The Host Hospital is required to complete this form and retain it for the record before sending/receiving Airvo™ 2 Nasal High Flow Nasal Cannula Device(s).
Airvo™ 2 Unit – Host Hospital Agreement
2021 | Forms
The Host Hospital is required to complete this form and submit as instructed before the release of an Airvo™ 2 Unit from the Provincial Stockpile
Airvo™ 2 Unit Requesting Hospital Checklist for Sending and Receiving Provincial Airvo™ 2 High Flow Devices
2021 | Forms
The Requesting Hospital is required to complete this form and retain it for the record before accepting/returning Airvo™ 2 Nasal High Flow Nasal Cannula Device(s).
Host Hospital Checklist for Sending and Receiving Provincial Ventilators (PDF)
2021 | Forms
The Host Hospital is required to complete this form and retain it for their records before sending/receiving Ventilator Device(s).
Host Hospital Checklist for Sending and Receiving Provincial Ventilators (Word)
2021 | Forms
The Host Hospital is required to complete this form and retain it for their records before sending/receiving Ventilator Device(s).
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Requesting Hospital Checklist for Sending and Receiving Provincial Ventilators (PDF)
2021 | Forms
The Requesting Hospital is required to complete this form and retain it for their records before receiving/returning Ventilator Device(s).
Requesting Hospital Checklist for Sending and Receiving Provincial Ventilators (Word)
2021 | Forms
The Requesting Hospital is required to complete this form and retain it for their records before receiving/returning Ventilator Device(s).
Doc
Service Inventory Change Request Form (June 2021)
2021 | Forms
This form is to be completed by critical care units that are reporting substantive changes to their hospital’s critical care capacity information.
CCIS Data Request Form (For Research)
2020 | Forms
This form must be completed in full by any individual or organization requesting access to data from the Critical Care Information System (CCIS) for research purposes
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CCIS Data Request Form (Not for Research)
2020 | Forms
This form must be completed in full by any individual or organization requesting access to data from the Critical Care Information System (CCIS).
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Partner Hospital Reporting Form (PDF)
2020 | Forms
To be completed by Partner Hospitals prior to joining the Moderate Surge teleconference (organized by CritiCall Ontario). This form has been developed to confirm resources available at the partner hospital in the event of a moderate surge.