Hospital Use Only

Hospital Use Only!

Forms are in Word Format

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Client List Form	Consent Form for Treatment
Client Wait List	CAPD CCPD Patient Form
Patient Information Form	Client Confirmation and Needs Form
Hemodialysis Prescription Form	Patient Information Package
Admission Criteria for Hemodialysis Patients Form	Supplies for Camp (visiting nurses)

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All visiting Units must submit a “Client List” and “Client Wait List” 3 weeks prior to unit assigned week.

“Confirmation and Special Needs” form is for Hemodialysis, PD and Transplant patients to complete and return to the Administrative Coordinator with requested deposit cheque at least 2 weeks prior to arrival.

Hemodialysis Patients Registration Forms Required:

Patient Information Form (required 3 weeks prior to arrival)

Hemodialysis Prescription Form (required 3 weeks prior to arrival)

Admission Criteria for Hemodialysis Patients Form (required upon arrival)

Consent Form for Treatment (required on arrival)

CAPD/CCPD Patients Registration Forms Required:

Patient Information Form (required 3 weeks prior to arrival)

Consent Form for Treatment (required on arrival)

Transplant Patients Registration Forms Required:

Patient Information Form (required 3 weeks prior to arrival)

*** PLEASE NOTE: Any additional pertinent medical information should be delivered to the Administrative Coordinator upon arrival. It is not required in advance .