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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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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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 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
Airvo™ 2 Unit Host Hospital Checklist for Sending and Receiving Provincial Airvo™ 2 Devices
2021 | Forms
o A checklist for Sending/Receiving Airvo™ 2 Unit(s) is required to ensure that all equipment (including consumables) required to safely operate the Airvo™ 2 Unit(s) is accounted for and to document the physical condition of the Airvo™ 2 Unit(s) before release.
o Must complete this form before sending out the Airvo™ 2 Unit(s) and upon receipt of the Airvo™ 2 Unit(s) from the Requesting Hospital. Please retain copies of these completed checklists for your records, and provide them if requested by CCSO or MOH
Airvo™ 2 Unit Requesting Hospital Checklist for Sending and Receiving Provincial Airvo™ 2 High Flow Devices
2021 | Forms
o A checklist for Sending/Receiving Airvo™ 2 Unit(s) is required to ensure that all equipment (including consumables) required to safely operate the Airvo™ 2 Unit(s) is accounted for and to document the physical condition of the Airvo™ 2 Unit(s) before release.
o Must complete this form upon receipt of the Airvo™ 2 Unit(s) from the Host Hospital and when sending back. Please retain copies of these completed checklists for your records, and provide them if requested by CCSO or MOH
Host Hospital Checklist for Sending and Receiving Provincial Ventilators (Word)
2021 | Forms
o A checklist for Sending/Receiving Ventilators is required to ensure that all equipment (including consumables) required to safely operate the ventilator(s) is accounted for and to document the physical condition of the ventilator(s) before release.
o Must complete this form before sending out the ventilator and upon receipt of the ventilator from the Requesting Hospital. Please retain copies of these completed checklists for your records, and provide them if requested by CCSO or MOH
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Host Hospital Checklist for Sending and Receiving Provincial Ventilators (PDF)
2021 | Forms
o A checklist for Sending/Receiving Ventilators is required to ensure that all equipment (including consumables) required to safely operate the ventilator(s) is accounted for and to document the physical condition of the ventilator(s) before release.
o Must complete this form before sending out the ventilator and upon receipt of the ventilator from the Requesting Hospital. Please retain copies of these completed checklists for your records, and provide them if requested by CCSO or MOH
Requesting Hospital Checklist for Sending and Receiving Provincial Ventilators (PDF)
2021 | Forms
o A checklist for Sending/Receiving Ventilators is required to ensure that all equipment (including consumables) required to safely operate the ventilator(s) is accounted for and to document the physical condition of the ventilator(s) before release.
o Must complete this form upon receipt of the ventilator from the Host Hospital and when sending back. Please retain copies of these completed checklists for your records, and provide them if requested by CCSO or MOH
Requesting Hospital Checklist for Sending and Receiving Provincial Ventilators (Word)
2021 | Forms
o A checklist for Sending/Receiving Ventilators is required to ensure that all equipment (including consumables) required to safely operate the ventilator(s) is accounted for and to document the physical condition of the ventilator(s) before release.
o Must complete this form upon receipt of the ventilator from the Host Hospital and when sending back. Please retain copies of these completed checklists for your records, and provide them if requested by CCSO or MOH
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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.
Partner Hospital Reporting Form (Word)
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.