PATH Unit Patient Assessment and Transition to Home

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PATH Unit Patient Assessment and Transition to Home

What you will need to bring: PATH Units in Fraser Health Appropriate footwear/street clothes Abbotsford Regional Hospital Toothbrush/Toothpaste/Denture 604 - 851-4849 cleaner / Shaving equipment Comb / Brush / Deodorant Burnaby Hospital 604 - 434-4211 Personal unscented creams or lotions Chilliwack General Hospital 604-795-4141 Special pillow or blanket Delta Hospital 604-946-1121 When you leave PATH Eagle Ridge Hospital PATH Unit The team will plan with you and 604-461-2022 your family for your return to home or community. Langley Memorial Hospital 604-534-4121 Patient Assessment You should ensure you have the and Transition following with you: Peace Arch Hospital 604 - 531-5512 All personal items to Home Medications from home and Queen’s Park Care Centre 604-519-8561 new prescriptions Dates and referrals for follow- Ridge Meadows Hospital 604-463-1822 up appointments You or your family are responsible Print Shop # 256155 for making follow-up appointments. PATH – Patient Assessment and Transition to Home PATH Working Together The PATH Team….. The PATH team is here to help The PATH unit will provide an You and your family you improve your ability to environment that promotes your Physician manage your care needs as strengths and abilities. The team Patient Care Coordinator independently as possible to will work with you and your family Quick Response Case Manager assist you in your transition to to develop a plan for your care Nursing Staff home or community. that is based on your needs. Care Aides Physiotherapist The team will keep you and your In order to maintain your well- Rehabilitation Assistant family informed of your care, being, the PATH team will Occupational Therapist share information, or review any encourage you to: Social Worker appropriate discharge planning. Dietitian do much of your own personal Pharmacist The PATH unit may be located at care another hospital site. If you have get up for meals any questions, ask anyone on the dress in your own clothing team. .

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AUTHORIZATION for the RELEASE of HEALTH RECORDS Please Fax Or Mail Your Completed Request to Each Hospital/Facility You Are Requesting Records From
AUTHORIZATION FOR THE RELEASE OF HEALTH RECORDS Please fax or mail your completed request to each hospital/facility you are requesting records from. ATTENTION: Health Information Management, Release of Information Office Part 1. Patient / Resident Information LAST NAME OF PATIENT FIRST NAME ALSO KNOWN AS / ALIAS MAILING ADDRESS CITY / PROVINCE / COUNTRY POSTAL CODE TELEPHONE NO. (INCLUDING AREA CODE) DATE OF BIRTH DAY | MONTH | YEAR PERSONAL HEALTH NUMBER (CARECARD) | | Part 2. Records Requested HOSPITAL(S)/FACILITY: □ VISIT SUMMARY □ EMERGENCY VISIT INFORMATION □ DIAGNOSTIC REPORTS (LAB/RADIOLOGY) □ PROOF OF VISIT □ OUTPATIENT □ OTHER (PLEASE SPECIFY): (fees may apply) DATE(S) OF RECORDS REQUESTED: ______________________ TO ___________________________________________ If you do not know exact dates please provide your best estimate Part 3. Person Receiving Records □ MYSELF OR □ NAME OF PERSON RECEIVING THE RECORDS NAME OF COMPANY OR ORGANIZATION (IF APPLICABLE) (LAST, FIRST) MAILING ADDRESS CITY / PROVINCE / COUNTRY POSTAL CODE TELEPHONE NO. (INCLUDING AREA CODE) RECORDS TO BE: □ MAILED □ PICKED UP (Picture ID Required) Part 4. Patient Authorization (12 years of age or older) I, the patient, authorize the Hospital(s)/Facility to release the records requested to the person named in the “Person Receiving Records” section. SIGNATURE OF PATIENT: ___________________________________________ DATE SIGNED: ____________________________ Part 5. Authorization on behalf of Patient (Please complete page 2 of form) (If patient is under 12 years of age or unable to authorize the release of personal information.) By signing below I confirm that I have legal authority to act on behalf of the patient and I hereby authorize the Hospital(s)/Facility to release the records requested to the person named in the “Person Receiving Records” section.
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