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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***
Closing the Gap
Costco Pharmacy
COTA Health
Coxwell Pharmacy
Dales Pharmacy
Danforth Medical Centre
Danforth Medical Clinic
Danforth Medical Pharmacy
Danforth Village Pharmacy
Davisville Family Practice
Dawes Drug Mart
Developmental Services Toronto Region
Dr. Mark Lachmann Medicine Professional Corporation
East End Community Health Centre
EastTCaN
Flemingdon Health Centre
Fontbonne Ministries***
Fred Victor***
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 Medical Centre
Peanut Plaza Medical Centre
Pharmacare Drug Mart
Pharmasave
Philip Aziz 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
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
This is a test only - to be deleted when ICP is moved to prod
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
WoodGreen
Woodgreen Pharmacy
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
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
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
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) - Housing (including Senior Services Coordinators)***
Social Worker (SW) - x-other settings/specialties*
Speech-Language Pathologist (SLP)
SW (Social Worker) - Case Management (including CCIST, MGH2Home)
This is for testing only - to be deleted when ICP is moved to Prod
TIP (Telemedicine IMPACT Plus) Facilitator
x - Other (please specify)*
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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