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First Name
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Last Name
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Personal Residence Postal Code (If you do not live in East Toronto, please choose "lives outside of East Toronto" or if you do not have a fixed address, please choose "no fixed address") Hint: Click the magnifying glass icon to search for your postal code.
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Email
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Organization
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Access Alliance Multicultural Health and Community Services#
Across Boundaries
Albany Medical Clinic#
Baycrest
Beech Medical Pharmacy
Birchcliff Pharmacy
Bridgepoint Family Health Team#
CAMH***
Care and Health Pharmacy
Closing the Gap#
Costco Pharmacy
COTA Health#
Coxwell Pharmacy
Daffodil Medical Pharmacy
Dales Pharmacy
Danforth Medical Centre
Danforth Medical Clinic
Danforth Medical Pharmacy
Danforth Pharmacy
Danforth Village Pharmacy
Davisville Family Practice
Dawes Drug Mart
Developmental Services Toronto Region***
Don Valley Pharmacy
Dr. Mark Lachmann Medicine Professional Corporation#
DVCLS (Don Valley Community Legal Services)#***
East End Community Health Centre#
EastTCaN (to be deleted)
Flemingdon Health Centre#
Fontbonne Ministries***
Fred Victor***
Glen George Pharmacy
Global Drug Mart
Greenwood Pharmacy
Guardian Pharmacy
Habitat Services***
Health Access Taylor Massey
HealthShield Pharmacy
Hennick Bridgepoint Hospital
Home Instead#
Houselink and Mainstay Community Housing***
Houses Opening Today Toronto***
IDA Pharmacy
L & A Pharmacy
Leaside Health Centre
Loblaws Pharmacy
LOFT***
Magenta Health
Main Drug Mart
Medi Choice Pharmacy
Medicare Drug Mart
Metro Pharmacy
Michael Garron Hospital#
Mount Sinai Hospital
N/A - Independent Primary Care Practice
Nymark Medical Centre
Ontario Health atHome
Pape Drug Mart
Pape Medical Centre
Peanut Plaza Medical Centre
Pharmacare Drug Mart
Pharmasave
Philip Aziz Centre***
Port Union Medical Centre
ProHealth Pharmacy
Providence Healthcare#
Reconnect Health Services
S.R.T. MedStaff#
Salvation Army***
Scarborough Academic Family Health Team
Shoppers Drug Mart
South East Toronto Family Health Team#
South Riverdale Community Health Centre#
Spectrum Health Care
St. Mary Pharmacy
St. Michael's Homes
St. Michael's Hospital
Stanbury's Pharmacy
Street Health Toronto#
Sumac Creek Health Centre
Sunnybrook Hospital
Taddle Creek Family Health Team
TAIBU Community Health Centre
The Claremont Retirment Residence***
The Neighbourhood Group#
The Neighbourhood Organization#
Toronto Community Paramedics
Toronto Seniors Housing Corporation#***
Toronto Western Hospital (UHN)
Ultimate Care Pharmacy
University Health Network
University of Toronto***
VHA Home Healthcare#
Victoria Health Centre
Warden Woods Medical Centre
Warden Woods Pharmacy
Women's College Hospital
Woodbine Heights Pharmacy
Woodgreen Pharmacy
WoodGreen#*
Woods Pharmacy
x. Other***
Organization Name (Please Specify)
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Program Team
Active Living Services***
Assisted Living
BSOT (Behaviour Support Outreach Team)
Caregiver Support***
CCIST (Comprehensive Care and Integration Specialist Team)
CCIST (Comprehensive Care and Integration Specialist Team)
COPA (Community Outreach Programs in Addiction)
COSS (Crisis Outreach for Seniors)
COSS (Crisis Outreach for Seniors)
Counselling & Support Services Team
DECNET (Diabetes Education Community Network of East Toronto)
EastTCaN (East Toronto Care Network)
ED (Emergency Department)
Financial Empowerment Counselling
FOCUS
Full Circle
HATM (Health Access Taylor-Massey)
HATM (Health Access Taylor-Massey)
HATM (Health Access Taylor-Massey)
HATP (Health Access Thorncliffe Park)
HATP (Health Access Thorncliffe Park)
HCLP (Home Care Leading Projects)
HCLP (Home Care Leading Projects)
HCLP (Home Care Leading Projects)
Home and Cluster Care
Living Well At Home***
Mental Health Outreach Services
MGH2Home
MGH2Home
MGH2Home
MGH2Home
Ontario Structured Psychotherapy Program
Other
Other
Other
Other
Other
Other
Other
Other
Other
Other
Other
Other
Other
Other
Other
Other
Other
Rapid Response Nurses (RRN)
RISE
Social Work
Telehomecare (THC)
TIP (Telemedicine IMPACT Plus)#
x-Other***
Role
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Access Administrator (AA) - EastTCaN
Administrator - ETHP Collaborate
Administrator - PCCRT
Behavior Support Specialist
Care Coordinator
Chiropodist/Podiatrist
Clinical Care Facilitator (CCF) - EastTCaN
Community Paramedic
Community Support Worker (including senior health and outreach workers)*
Homecare Coordinator
Homecare Service Provider
Housing Support Staff (excluding social workers)***
Manager, Supervisor, or Director*
Nurse Practitioner (NP) - primary care
Nurse Practitioner (NP) - x-other settings/specialties
Occupational Therapist (OT)
Pharmacist
Physician (MD) - emergency medicine
Physician (MD) - endocrinology
Physician (MD) - geriatrics
Physician (MD) - primary care
Physician (MD) - psychiatry/geriatric psychiatry
Physician (MD) - x-other settings/specialties
Physician Assistant (PA) - primary care
Physician Assistant (PA) - x-other settings/specialties
Physiotherapist (PT)
RD (Registered Dietitian)
Registered Nurse (RN) - footcare
Registered Nurse (RN) - mental health or geriatrics
Registered Nurse (RN) - x-other settings/specialties
Registered Practical Nurse (RPN)
Respiratory Therapist (RT)
Social Worker (SW) - Case Management (including CCIST, MGH2Home)
Social Worker (SW) - Housing (including Senior Services Coordinators)***
Social Worker (SW) - x-other settings/specialties
Speech-Language Pathologist (SLP)
TIP (Telemedicine IMPACT Plus) Facilitator
Other (Role)
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Purpose of Access
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1. Referring my client (to PCCRT or SMHC)
2. Submitting a case (for discussion at PCCRT or SMHC rounds)
3. Accessing my client's existing coordinated care plan (CCP)
4. Other (note: you will be contacted and asked to provide further details)
Manager/Supervisor (Email)
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