Home and Community Care Regional Medical Supplies List

Home and Community Care Regional Medical Supplies List December 6, 2017 Table of Contents Medical Supplies Depot/Drop-off Locations 1 Algoma 1 Nipissing 2 Temiskaming 3 Cochrane 4 Sudbury-Manitoulin-Parry Sound 5 Dressings, Bandages, Tape, Compression & Wraps 8 Gauze, Sponges & Packing 8 Tapes & Securement 9 Bandages & Wraps 10 Compression Wraps 11 Other, Specialty & Kits 11 Wound Care 13 Absorptives 13 Gelling Fiber & Antimicrobials Silver Gelling Fiber 13 Alginate & Antimicrobial Silver Alginate Dressings 14 Antimicrobial & Silver Dressings 14 Composite & Multifunction Dressings 16 Clear Acrylic Dressings 17 Foams 17 Hydrocolloids 18 Hydrogel 18 Films & Membranes 19 Odour Absorbent Dressings 19 Non-adherent 19 Other, Specialty & Kits 20 Negative Pressure Wound Therapy (NPWT) 24 Reusable Foam NPWT 24 Disposable Single-use NPWT 25 Cleansers & Antiseptic Solutions 27 Urinary Supplies 28 Foley Catheters 28 Intermittent Catheters 29 Urinary Drainage Bags 29 Catheter Stabilization 30 Catheter Accessories 30 Urinary Kits 31 Ostomy Supplies and Accessories 33 Ostomy Skin Barriers for 2 Piece System 33 Urostomy Pouches for 2 Piece System 34 Drainable Pouches for 2 Piece System 34 One Piece Urostomy System 35 One Piece System with Drainable Pouches 35 Pediatric 2 Piece System 36 Ostomy Accessories 36 Feeding, Suction & Tracheostomy Supplies 39 Enteral Feeding 39 Suction Catheters, Tubing and Accessories 40 Tracheostomy Products 41 Oxygen Monitoring 42 I.V. Supplies 43 Needles & Syringes 43 Prefilled Syringes 44 I.V. Solutions 44 I.V. Catheters and Access 45 I.V. Gravity Sets & Extension Sets 45 I.V. Dressings 45 Infusion Pump & Supplies 46 Blood Collection Supplies 46 Other IV Supplies & Accessories 46 IV Kits 48 Protective Wear 54

The NE LHIN Home & Community Care Regional Medical Supplies List identifies the LHIN-funded items available to eligible patients authorized for Home & Community Care Services as per LHIN policies. If a different products are requested, an automatic substitution policy may be initiated to provide the equivalent product approved by the LHIN as identified within this list. The LHIN is not obligated to fund or provide any items that are not identified on this list.

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NORTH EAST LHIN MEDICAL SUPPLIES DEPOT/DROP-OFF LOCATIONS ALGOMA (Questions or issues call: 705-949-1808 / 1-800-668-7705 Ext: 3269) Service Depot/Drop-Off Availability For Regular Pick-Up Location Service Type Area Location Scheduled Pick-up* URBAN LHIN Sault Ste. 390 Bay Street, Suite 103, MON-FRI 8:30AM - 4:30PM LHIN Medical Supplies SSM01 Marie Office Sault Ste. Marie, ON P6A 1X2 Infusion (IV) Equipment & 705-949-1650/800-668-7705 Supplies Fax: 705-949-3844 URBAN The Medicine 316 Second Line West MON-FRI 9:00AM– 6:00PM Medicine Shoppe’s SSM02 Shoppe Sault Ste. Marie, ON P6C 2J5 SAT 9:00AM–2:00PM Infusion (IV) Equipment & 705-253-7656/877-374-6938 Supplies Fax: 705-256-7656 URBAN ParaMed Clinic 477 Queen Street East MON-FRI 8:00AM– 8:00PM LHIN Medical Supplies SSM03 Suite 100 SAT-SUN 8:00AM– 8:00PM Sault Ste. Marie, ON, P6A 1Z5 For Clinic patients only 705-759-0110 URBAN Algoma 229 Fourth Line W Sault Ste., Orders arrive weekly on LHIN Medical Supplies & SSM13 Residential Marie, ON P6A 0B5 Tuesdays and Fridays Medicine Shoppe’s Hospice Care 705-942-1556 Available only for Hospice Infusion (IV) Equipment & (ARCH) Residents Supplies RURAL Matthews 1180 Richards Street, Orders arrive weekly on LHIN Medical Supplies SSM04 Memorial Richards Landing, ON P0R 1J0 Thursdays Hospital 705-246-2570 Open 24 hrs RURAL Nugget Food 9153 Hwy 17 East Orders arrive weekly on LHIN Medical Supplies SSM05 Store c/o Copper Bruce Mines P0R 1C0 Fridays Bay Shell 705-785-3713 MON-SUN 5:30AM – 10:00PM RURAL Thessalon 135 Dawson Street Orders arrive weekly on LHIN Medical Supplies SSM06 Hospital Thessalon, ON P0R 1L0 Thursdays 705-842-2014 Open 24 hrs RURAL Pit Stop Gas Bar 3245 Hwy 17 East, Orders arrive weekly on LHIN Medical Supplies SSM07 & Confectionary Echo Bay, ON P0S 1C0 Fridays 705-248-3333 MON-SUN 6:00AM – 11:00PM RURAL Goulais River 2771 Hwy 17 North Orders arrive weekly on LHIN Medical Supplies SSM08 Country Store Goulais River, ON P0S 1E0 Fridays 705-649-3811 MON-SUN 6:00AM -11:00PM RURAL McCauley’s 5235 Hwy 17 North Orders arrive weekly on LHIN Medical Supplies SSM09 Village Store Haviland Bay, ON P0S 1E0 Fridays 705-649-5813 MON-SUN 8:30AM – 10:00PM RURAL Elliot Lake 267 Hillside Drive South MON-FRI 9:00AM–5:00PM Robinson’s Medical SSM10 PharmaChoice Elliot Lake, ON P5A 1N7 SAT 9:00AM – 1:00PM Supplies & Infusion (IV) 705-848-0004 Equipment & Supplies RURAL Home Hardware 275 Imperial St MON-THUR 8:00AM-6:00PM Robinson’s Medical SSM11 Massey, ON P0P 1P0 FRI 8:00AM-8:00PM Supplies 705-865-2135 SAT 8:00AM-5:00PM RURAL LHIN Wawa 17 Government Road MON-FRI 8:30AM-4:30PM LHIN Medical Supplies SSM12 Office Wawa, ON P0S 1K0 705-856-7018 Fax: 705-856-1776 RURAL Patient Service Patients living in the defined MON-FRI 8:30AM-4:30PM Robinson’s Medical SSM13 Treatment Blind River area are pre- Supplies & Infusion (IV) Location authorized for home delivery FRI-SUN Only available for Equipment & Supplies because there is no available New Patients or Patient depot. Resumes/ Hospital Discharges /End of Life

Deliveries during extended hours: Only available for New Patients or Patient Resumes/ Hospital Discharges/End of Life Private-Pay Patient Home Deliveries: IN SSM PROPER $5.00, OUTLYING AREAS $6.00-20.00 (STILL WITHIN CITY LIMITS), In ELLIOT LAKE - Call Robinson’s for price (705) 566-5592

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 1 of 54 NORTH EAST LHIN MEDICAL SUPPLIES DEPOT/DROP-OFF LOCATIONS

NIPISSING (Questions or issues call: 705-476-2220 / 1-888-533-2222 Ext: 2235)

Service Depot/Drop-Off Availability For Regular Pick-Up Location Service Type Area Location Scheduled Pick-up* URBAN LHIN North Bay 1164 Devonshire Ave. MON-FRI 8:30AM - 4:30PM LHIN Medical Supplies NB01 Office North Bay, ON P1B 6X7 705-476-2222 Fax: 705-474-2369

URBAN VON Clinic 180 Shirreff Avenue MON-SUN 8:00AM – 8:00PM LHIN Medical Supplies NB02 Unit #195 For Clinic patients only North Bay, ON P1B 7K9 705-472-8050 Fax: 705-495-6691

URBAN Robinson’s 2547 Trout Lake Road MON-FRI 9:00AM - 6:00PM Robinson’s Medical Supplies & NB03 Pharmasave North Bay, ON P1B 7S8 SATURDAY 9:00AM - 5:00PM Infusion (IV) Equipment & 705-495-4515 SUNDAY 10:00AM - 2:00PM Supplies

RURAL Pharmacie 26 Principale Street East MON-FRI 9:00AM - 6:00PM Robinson’s Medical Supplies & NB04 Nipissing Verner, ON P0H 2M0 Infusion (IV) Equipment & Pharmacy, 705-581-2013 Supplies PharmaChoice RURAL ParaMed Clinic 725 Coursol Road For Clinic Patients only LHIN Medical Supplies NB05 Sturgeon Falls, ON P2B 2Y6 705-753-3110

RURAL Mattawa IDA 300 Main Street MON-THUR 9:00AM – 5:30PM Robinson’s Medical NB06 Mattawa, ON P0H 1V0 FRIDAY 9:00AM – 6:00PM Supplies & Infusion (IV) 705-744-2625 SATURDAY 9:00AM – 5:00PM Equipment & Supplies RURAL South River 22 Marie St. MON-FRI 9:00AM – 5:30PM Robinson’s Medical Supplies & NB07 Pharmacy South River, ON P0A 1X0 SATURDAY 9:00AM - 2:00PM Infusion (IV) Equipment & 705-386-0636 Supplies

RURAL Loblaws 12035 Hwy #17 MON-FRI 8:00AM – 9:00PM Robinson’s Medical Supplies & NB09 Pharmacy Sturgeon Falls, ON P2B 2S6 SATURDAY 9:00AM – 5:30PM Infusion (IV) Equipment & (No Frills) 705-753-5850 Supplies SUNDAY 9:00AM - 5:30PM

RURAL Clement’s IDA 497 Main St MON-FRI 9:00AM – 6:00PM Robinson’s Medical Supplies & NB11 Powassan, ON P0H 1Z0 SATURDAY 9:00AM – 3:00PM Infusion (IV) Equipment & 705-724-3523 Supplies

RURAL Argyle Nursing 11851 Hwy 522 MON 10:00AM – 6:00PM Robinson’s Medical Supplies NB12 Station Port Loring, ON P0H 1Y0 TUE 8:00AM – 4:00PM 705-757-1717 WED 8:00AM – 8:00PM THUR 8:00AM – 4:00PM Closed daily 12:00-13:00 as well as Wed 16:30-17:30 RURAL Arnica Medical 162 Huston St. MON – THU 9:00AM – 5:30PM Robinson’s Medical Supplies & NB13 Pharmacy Burks Falls, ON P0A 1C0 FRI 9:00AM – 5:00PM Infusion (IV) Equipment & 705-382-2111 Supplies

RURAL Sundridge 107 Main St. MON – FRI 9:00AM-6:00PM Robinson’s Medical Supplies NB14 Guardian Sunridge, ON P0A 1Z0 SAT 9:00AM – 5:00PM and Infusion (IV) Equipment & Pharmacy 705-384-5335 Supplies

Deliveries during extended hours: Only available for New Patients or Patient Resumes/ Hospital Discharges/End of Life Private-Pay Patient Deliveries: U-Need-A-Cab Phone: 705-497-7777 ($11 - $12 delivery charge). For Robinson’s Medical Supplies and IV – Call Robinson’s for delivery price (705) 566-5592

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 2 of 54 NORTH EAST LHIN MEDICAL SUPPLIES DEPOT/DROP-OFF LOCATIONS TEMISKAMING (Questions or issues call: 705-567-2222) Ext: 7622

Availability For Regular Scheduled Pick-up* Service Depot/Drop-Off Weekly supplies available for Service Type Area Location Pick-Up Location patient pick-up each Wednesday RURAL LHIN Kirkland 53 Government Rd W MONDAY - FRIDAY LHIN Medical Supplies KL01 Lake Office Kirkland Lake, ON P2N 2E5 8:30AM – 4:30PM 705-567-2222/888-602-2222 Fax: 705-567-9407

RURAL LHIN Haileybury 240 Georgina Avenue, Suite MONDAY - FRIDAY LHIN Medical Supplies KL02 Office 112 Haileybury, ON POJ 1KO 8:30AM – 4:30PM 705-672-2222/888-602-2222 Fax: 705-672-3887 ext:7622

RURAL Findlay’s Drug 25-247 Whitewood Ave. MON-FRI 8:00AM – 8:00PM LHIN Medical Supplies KL03 Store New Liskeard, ON P0J 1P0 SATURDAY 8:00AM – 5:30PM 705-647-8186 SUNDAY 10:00AM – 5:00PM

RURAL Latchford Town 10 Main St. MONDAY - FRIDAY LHIN Medical Supplies KL04 Office Latchford, ON P0J 1N0 8:30AM – 4:00PM

RURAL Temagami 17 O’Connor Dr. MONDAY – FRIDAY LHIN Medical Supplies KL05 Family Health Temagami, ON P0H 2H0 8:30AM – 5:00PM Team 705-569-3244

RURAL Garlin’s 56 4th Ave. MONDAY – THURSDAY LHIN Medical Supplies KL06 Gift Gallery Englehart, ON P0J 1H0 8:30AM – 5:30PM 705-544-8050 FRIDAY 8:30AM – 8:00 PM SATURDAY 8:30AM – 5:30PM

RURAL J&S Variety 91 Pine Street MONDAY – SUNDAY LHIN Medical Supplies KL07 Store Elk Lake, ON P0J 1G0 5:00AM – 11:00PM

RURAL Larder Lake 25 Godrey Street MONDAY – SATURDAY LHIN Medical Supplies KL08 Co-Op Larder Lake, ON P0K 1L0 10:00AM – 8:00PM 705-643-2327 SUNDAY 11:00AM – 4:00PM

RURAL Chez Lucie 1-42 Connell Ave MONDAY – SATURDAY LHIN Medical Supplies KL09 Virginiatown, ON P0K 1X0 9:00AM – 9:00PM 705-634-2228 RURAL Cote’s Variety 16 Tenth St. E MONDAY – SUNDAY LHIN Medical Supplies KL10 Store Earlton, ON P0J 1E0 7:00AM – 10:00PM 705-563-2022

RURAL Matachewan 1 Moyneur Ave MONDAY – THURSDAY LHIN Medical Supplies KL11 Nursing Station Matachewan, ON P0K 1M0 9:30AM – 12: 30PM & 705-565-2351 1:00PM – 3:00PM FRIDAY 9: 30AM-12:00PM

RURAL Bayshore 70 Esna Park Drive Unit 11 Next day delivery from Bayshore Rx IV Supplies & KL12 Specialty Rx Markham, ON L3R 6E7 Markham Equipment 905-474-0822/888-313-6988 MON 9:00AM – 5:00PM(Only if order sent on previous Friday) TUES-FRI 9:00 AM – 5:00PM

Note: All IV orders from Bayshore Rx are delivered to the patient’s treatment location as defined by the LHIN Care Coordinator in the order

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 3 of 54 NORTH EAST LHIN MEDICAL SUPPLIES DEPOT/DROP-OFF LOCATIONS COCHRANE (Questions or issues call: 705-267-2234/888-668-2222) Service Depot/Drop-Off Availability For Regular Pick-Up Location Service Type Area Location Scheduled Pick-up* URBAN LHIN Timmins 330 Second Avenue, Suite 101 MONDAY – FRIDAY LHIN Medical Supplies TIM01 Office Timmins, ON P4N 8A4 8:30 AM – 4:30PM 705-267-2234/888-668-2222 Fax: 705-267-7795 URBAN Bayshore Home 202-119 Pine Street S MONDAY – SUNDAY LHIN Medical Supplies TIM02 Health Clinic Timmins, ON P4N 2K3 8:00 AM – 8:00PM 705-268-6088/866-227-3661 Fax: 705-268-9085 For clinic patients only

URBAN/ Bayshore 70 Esna Park Drive Unit 11 Next day delivery from Markham Bayshore Rx IV Supplies RURAL Specialty Rx Markham, ON L3R 6E7 MON 9:00AM – 5:00PM (Only if & Equipment TIM03 905-474-0822/888-313-6988 order sent on previous Friday) TUES-FRI 9:00 AM – 5:00PM RURAL LHIN Matheson/ Anson General Hospital MONDAY – FRIDAY LHIN Medical Supplies TIM04 Iroquois Falls 58 Anson Drive 8:30AM – 4:30PM (Bayshore Rx Office Iroquois Falls, ON P0K 1E0 BodyGuard IV pump 1-888-668-2222 available at clinic) Fax: 705-258-2296

RURAL Bingham Bingham Hospital For clinic patients only LHIN Medical Supplies TIM05 507 Eight Avenue (Basement) Hospital (Bayshore Rx Matheson, ON P0K 1N0 BodyGuard IV pump 705-273-4500 available at clinic) RURAL Smooth Rock 101 Kelly Road MON 9:00AM – 4:15PM LHIN Medical Supplies TIM06 Falls Medical Smooth Rock Falls, ON P0L 2B0 WED/TUES/THURS Clinic 705-338-2788 9:00AM – 2:00PM Fax:705-338-2933 FRI 9:00AM – 12:30PM RURAL LHIN Sensenbrenner Hospital MONDAY – FRIDAY LHIN Medical Supplies TIM07 Kapuskasing 101 Progress Crescent 8:30AM – 4:30PM Office Kapuskasing, ON P5N 3H5 888-668-2222 Fax: 705-337-4080

RURAL LHIN Cochrane P.O Box 1750, 22E 5th Street MONDAY – FRIDAY LHIN Medical Supplies TIM08 Office Cochrane, ON P0L 1C0 8:30AM – 4:30PM 877-513-2626 Fax: 705-272-2600

RURAL LHIN Hearst PO Box 547 MONDAY – FRIDAY LHIN Medical Supplies TIM09 Office 1403B Edward Street 8:30AM – 4:30PM (Bayshore Rx Hearst ON P0L 1N0 BodyGuard IV pump 705-362-6633 available at clinic and Fax: 705-362-6635 office). RURAL LHIN Moosonee PO Box 57, 48 Revillion St. MONDAY – FRIDAY LHIN Medical Supplies TIM10 Office Moosonee ON, P0L 1Y0 8:30AM – 4:30PM 705-336-2233 Fax: 705-336-2919 RURAL Honger 12 Birch St. West MONDAY – FRIDAY LHIN Medical Supplies TIM11 Redwood Inn Chapleau, ON POM 1K0 9:00AM – 7:00PM Chapleau 705-864-1311

RURAL Jr Corner Store 41 Poupore St, MONDAY – THURSDAY LHIN Medical Supplies TIM12 Gogama Gogama, ON, P0M 1W0 8:00AM –7:00PM 705-894-2540 FRIDAY & SATURDAY Attention: Gogama Nursing Clinic 8:00AM – 8:00PM

Private-Pay Patient Deliveries for LHIN Supplies: C&G delivery ($2 - $3).

Note: All IV orders from Bayshore Rx are delivered directly to the patient’s treatment location

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 4 of 54 NORTH EAST LHIN MEDICAL SUPPLIES DEPOT/DROP-OFF LOCATIONS SUDBURY-MANITOULIN-PARRY SOUND (Questions or issues call: Robinson’s Pharmasave (705) 566-5592)

Service Depot/Drop-Off Availability For Regular Pick-Up Location Service Type Area Location Scheduled Pick-up* URBAN Health Care 1276 Lasalle Blvd. MON-FRI 9:00AM-9:00PM Robinson’s Medical SUD01 Pharmacy Sudbury, ON P3A 1Y8 SATURDAY 9:00AM-6:00PM Supplies and IV Equipment Pharmasave (705) 566-5592 SUNDAY 9:00-6:00PM & IV Supplies

URBAN NE LHIN 865 Regent MONDAY – SUNDAY Robinson’s Medical SUD02 Ambulatory Sudbury, ON 7:00AM – 9:00PM Supplies and IV Equipment Nursing Clinic P3E 3Y9 For clinic patients only & IV Supplies LHIN Medical Supplies URBAN Corner Clinic 344 Elgin, Sudbury, MON-WED-FRI Robinson’s Medical SUD03 ON P3E 3N9 8:00AM –2:30PM Supplies 705-673-3721 THURS 8:00AM-2:00PM (Closed between 12:00-1:00PM) URBAN Daffodil Lodge 41 Ramsey Lake Rd. MONDAY – FRIDAY Robinson’s Medical SUD04 Sudbury, ON P3E 5J1 9:00AM-5:00PM Supplies

URBAN ICAN (Haig) 765 Brennan Road MONDAY – FRIDAY Robinson’s Medical SUD05 Sudbury, ON P3C 1C4 9:00AM-5:00PM Supplies

URBAN ICAN 117 Mont Adam MONDAY – FRIDAY Robinson’s Medical SUD06 (Mont Adam) Sudbury, ON P3B 1E1 9:00AM-5:00PM Supplies

URBAN Sudbury Maison 1028 South Bay MONDAY – SUNDAY Robinson’s Medical SUD07 McCulloch Sudbury, ON P3E 6J7 8:00AM – 6:00PM Supplies and IV Equipment Hospice 705-674-9252 For Hospice Residents only & IV Supplies

URBAN Health Sciences 41 Ramsey Lake Rd LHIN use only - Distributed by Robinson’s Medical SUD08 North Sudbury, ON the LHIN as required to Supplies and IV Equipment P3E 5J1 facilitate hospital discharges & IV Supplies only LHIN Medical Supplies URBAN LHIN Sudbury 40 Elm St. Suite 41-C For LHIN clinicians use only – Robinson’s Medical SUD09 Office Sudbury, ON P3C 1S8 Not for patient pick-up Supplies 705-522-3460 URBAN Chelmsford 46 Main St. MON–TUES 9:00AM – 9:00PM Robinson’s Medical SUD10 Guardian Chelmsford, ON P0M 1L0 WED-FRI 9:00 AM – 7:00PM Supplies Pharmacy 705-855-2371 SATURDAY 9:00AM – 5:30PM

URBAN Wellness 1769 Regent St. MON – FRI 9:30AM – 7:00PM Robinson’s Medical SUD11 Shoppe Sudbury, ON P3E 3Z7 SATURDAY 9:00AM – 5:00PM Supplies 705-522-9159 URBAN Coniston 24 Amanda St. MON – WED 9:00AM – 6:00PM Robinson’s Medical SUD12 Guardian Coniston, ON P0M 1M0 THURS-FRI 9:00AM – 9:00PM Supplies 705-694-5346 SATURDAY 9:00AM – 5:30PM URBAN Wilson 10 Serpentine St. MONDAY – FRIDAY Robinson’s Medical SUD13 Pharmacy Copper Cliff, ON P0M 1N0 9:00AM – 5:30PM Supplies Pharmasave 705-682-2841 URBAN Nickel Centre 3098 Falconbridge Hwy, MON – FRI 9:00AM – 9:00PM Robinson’s Medical SUD14 Pharmacy, Garson, ON P3L 1P5 SATURDAY 9:30AM – 5:30PM Supplies Pharmasave 705-693-2738 SUNDAY 11:00AM – 4:00PM

URBAN Val Est 3179 Hwy 69 N, Unit # 1 MON – FRI 9:00AM – 9:00PM Robinson’s Medical SUD15 Pharmacy, Val Caron, ON P3N 1S5 SATURDAY 9:30AM – 5:30PM Supplies and IV Equipment Pharmasave 705-897-1867 SUNDAY 11:00AM – 4:00PM & IV Supplies URBAN Walden 135 Regional Rd. 24 MON – FRI 9:00AM – 6:00PM Robinson’s Medical SUD16 Medicine Walden Plaza SATURDAY 9:00AM – 5:00PM Supplies Shoppe 705-692-5868

Deliveries during extended hours: Only available for New Patients or Patient Resumes/ Hospital Discharges/End of Life Private-Pay Patient Deliveries: Call Robinson’s for current price (705) 566-5592

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 5 of 54 NORTH EAST LHIN MEDICAL SUPPLIES DEPOT/DROP-OFF LOCATIONS SUDBURY-MANITOULIN-PARRY SOUND (Questions or issues call: Robinson’s Pharmasave (705) 566-5592)

Service Depot/Drop-Off Availability For Regular Area Pick Up Location Scheduled Pick-up* Service Type URBAN Lalonde 23 Yonge St. Capreol, ON MON-THURS 9:00AM – 5:30PM Robinson’s Medical SUD17 Pharmacy 705-858-1231 FRIDAY 9:00AM – 6:00PM Supplies

SATURDAY 10:00PM – 3:00PM URBAN Dowling 30 Main St. MON – WED 9:00AM – 6:00PM Robinson’s Medical SUD18 Pharmacy Dowling, ON THURS 9:00AM – 7:00PM Supplies 705-855-4562 FRI 9:00 – 9:00PM SATURDAY 9:00AM – 5:30PM URBAN Levack 2 – 1st Ave North MONDAY – FRIDAY Robinson’s Medical SUD19 Pharmacy Onaping Falls, ON 9:00AM - 5:00PM Supplies 705-966-3612 RURAL Hagar General 7147 Hwy 17 E, MON – FRI 8:00AM – 7:00PM Robinson’s Medical SUD20 Store Hagar, ON SATURDAY 9:00AM – 7:00PM Supplies 705-599-2060 SUNDAY 9:00AM – 5:00PM

RURAL Noelville 27 St David N, MON-THURS 9:00AM – 5:30PM Robinson’s Medical SUD21 Pharmacy Noelville, ON P0O 2N0 FRIDAY 9:00AM – 6:00PM Supplies and IV Equipment 705-898-2999 & IV Supplies SATURDAY 9:00AM – 4:00PM RURAL St. Charles 25 Main St. MON-FRI 8:00AM – 7:00PM Robinson’s Medical SUD22 Cooperative St. Charles, ON SATURDAY 8:00AM – 7:00PM Supplies Store 705-867-2000 SUNDAY 9:00AM – 6:00PM

RURAL Pitfield General 7 Channel MON-FRI 8:00AM – 5:00PM Robinson’s Medical SUD23 Store Killarney, ON P0M 2A0 SATURDAY 9:00AM – 5:00PM Supplies 705-287-2872 SUNDAY 10:00AM – 5:00PM RURAL Robinsons 119 Tudhope MON-FRI 9:00AM – 5:00PM Robinson’s Medical SUD24 Pharmasave Espanola, ON SATURDAY 10:00AM – 2:00PM Supplies and IV Equipment 705-869-1561 & IV Supplies RURAL Home Hardware 275 Imperial St MON-THURS 8:00AM – 6:00PM Robinson’s Medical SUD25 Massey, ON P0P 1P0 FRIDAY 8:00AM – 8:00PM Supplies 705-865-2135 SATURDAY 8:00AM – 5:00PM RURAL Little Current 41 Meredith St MON-THURS 9:00AM – 5:30PM Robinson’s Medical SUD26 Guardian Little Current, ON P0P 1K0 FRIDAY 9:00AM – 7:00PM Supplies and IV Equipment 705-368-2530 & IV Supplies SATURDAY 9:00AM – 5:30PM SUNDAY 10:00AM – 2:00PM RURAL Manitowaning 1 Wellington MONDAY – SATURDAY Robinson’s Medical SUD27 Pharmacy Manitowaning, ON P0P 1N0 9:00AM – 5:30PM Supplies 705-859-2323

RURAL Mindemoya Guardian Pharmacy MON-THURS 9:00AM – 6:00PM Robinson’s Medical SUD28 Pharmacy 11 Yonge St. FRIDAY 9:00AM – 7:00PM Supplies and IV Equipment Mindemoya, ON P0P 1S0 & IV Supplies SATURDAY 9:00AM – 6:00PM 705-377-5411 SUNDAY 10:00AM – 2:00PM RURAL Robertson IDA 39 Meredith Street MONDAY – SATURDAY Robinson’s Medical SUD29 Gore Bay, ON P0P 1H0 9:00AM – 5:30PM Supplies and IV Equipment 705-282-2147 & IV Supplies

RURAL Central Meredith Street MONDAY – SATURDAY Robinson’s Medical SUD30 Guardian Gore Bay, ON P0P 1H0 9:00AM – 5:30PM Supplies Pharmacy 705-282-2409

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 6 of 54 NORTH EAST LHIN MEDICAL SUPPLIES DEPOT/DROP-OFF LOCATIONS SUDBURY-MANITOULIN-PARRY SOUND (Questions or issues call: Robinson’s Pharmasave (705) 566-5592)

Service Depot/Drop-Off Availability For Regular Pick-Up Location Service Type Area Location Scheduled Pick-up* RURAL Britt Nursing Box 97 MON - THURS 8:00AM-4:00PM Robinson’s Medical Supplies PS01 Station Parry Sound, ON P0G 1A0 FRIDAY 8:00AM-12:00PM 705-383-2375

RURAL Duck Rock 2093 124 Hwy MONDAY – SUNDAY Robinson’s Medical Supplies PS02 General Store Dunchurch, ON P0A 1G0 8:00AM – 7:00PM 705-389-3322

RURAL Lane Family 4 Pine Parry Sound MON-FRI 9:00AM – 6:00PM Robinson’s Medical Supplies PS03 Pharmasave Parry Sound, ON P2A 3B8 SATURDAY 9:00AM – 5:00PM & Infusion (IV) Equipment & 705-746-2187 SUNDAY 10:00AM – 4:00PM Supplies

RURAL Rosseau General 1 Rice Winter (Sep-June) Robinson’s Medical Supplies PS04 Store Parry Sound, ON P2A 2W9 MON-FRI 7:30AM – 6:00PM 705-732-4479 SATURDAY 8:00AM – 6:00PM SUNDAY 9:00AM – 4:00PM Summer (July-Aug) MON-FRI 7:30AM – 7:00PM SATURDAY 8:00AM – 7:00PM SUNDAY 9:00AM – 5:00PM RURAL LHIN Parry Sound 70 Joseph St. For LHIN clinicians use only Robinson’s Medical Supplies PS05 Office Parry Sound, ON P2A 2G5 Not for patient pick-up and LHIN Medical Supplies 705-773-4602

RURAL West Parry Sound 6 Albert Street Distributed by the LHIN as Robinson’s Medical Supplies PS06 Hospital Parry Sound, ON P2A 3A4 required to facilitate hospital and LHIN Medical Supplies discharges only

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 7 of 54 North East LHIN Home & Community Care Regional Approved Medical Supplies List

DRESSINGS, BANDAGES, TAPE, COMPRESSION & WRAPS

Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Max GAUZE, SPONGES & PACKING: Woven gauze has a loose, open weave, which allows fluids from the wound to be absorbed into the fibers, wicked away, or passed through into other absorbent materials in the wound’s dressing. Woven gauze shouldn’t be cut and placed in a wound because loose fibers (lint) may get lost in the wound and delay healing. Nonwoven gauze consists of fibers pressed together to resemble a weave, which are stronger, bulkier, and softer than woven pads and provides improved wicking and greater absorbent capacity.

ROLL BANDAGES: Knitted stretch gauze in roll configuration used as secondary dressing for limbs and to hold dressings in place. Includes sterile and non-sterile.

Gazetex bandage rolls are washed, low-linting woven gauze rolls; 6-ply. Derma Sciences 2.25" x 3 yards These bandages are used for wrapping or packing large and deep SDR-0020 Sterile Small Woven Gauze 2" Roll Gazetex Y 7 DUP9321 5.7 cm x 2.7 m wounds. When used as a primary dressing, the dressing provides fast wicking, absorbency, and aeration. When used as a secondary Derma Sciences 4.5" x 4 yards dressing, the dressing provides additional cushioning and comfort. SDR-0021 Sterile Large Woven Gauze 4" Roll Gazetex Y 7 DUP9322 11.4cm x 3.7m Does not contain natural rubber latex Derma Sciences 2" x 4.1 yards SDR-0007 Conforming Stretch Bandage Wrap 2" (Roll) Duform Y 7 DUP75102 5 cm x 3.75 m Synthetic knitted stretch bandage ideal as a secondary dressing. Non- Derma Sciences 4"x 4.1 yards Sterile SDR-0008 Conforming Stretch Bandage Wrap 4" (Roll) Duform Y 7 DUP75104 10cm x 3.75m Derma Sciences 4" x 4.1 yards Cotton, 2 ply woven bandage ideal as a secondary dressing. Non- SDR-0060 Conforming Cotton Bandage 4" (Roll) Dutex Y 7 DUP76783 10cm x 3.75m stretch and Non-sterile DRESSINGS AND PACKING: Sterile dressing products to cover surgical incisions to control bleeding, absorb exudate, provide protection, and non-sterile products to secure primary dressings in place. Derma Sciences 1-5/8" x 2-5/8" SDR-0013 Oval Eye Pad Non-woven Sterile Surecare Y 7 DUP82911 4 x 6.5 cm Derma Sciences 5" x 9" SDR-0001 Abdominal Pad Sterile 5"x9" Dupad Y 7 Non-woven; non-adherent DUP87059 12.7 x 22.8 cm Derma Sciences 8" x 10" SDR-0002 Abdominal Pad Sterile 8"x10" Dupad Y 7 Non-woven; non-adherent DUP87810 20 x 25 cm Derma Sciences 2" x 2" 14 SDR-0003 Gauze Sterile Woven 2"x2" (2 per Pack) Ducare Y Cotton, 12 Ply, Pack of 2 DUP82212 5 x 5 cm Packs of 2 Derma Sciences 4" x 4" 14 SDR-0004 Gauze Sterile Woven 4"x4" (2 per Pack) Ducare Y Cotton, 8 Ply, Pack of 2 DUP82408 10 x 10cm Packs of 2

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 8 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Max Derma Sciences 1/4" x 5 yards SDR-0017 Sterile Packing Plain 1/4" (Bottle) PAK-ITS Y 2 DUP59120 0.64cm x 4.5m Single-ply ribbon gauze strips that can be used dry to absorb drainage in exuding wounds or soaked with a medication of choice. A secondary Derma Sciences 1/2" x 5 yards SDR-0018 Sterile Packing Plain 1/2" (Bottle) PAK-ITS Y 2 dressing is needed to hold the strips in place and to protect the wound DUP59220 1.27cm x 4.5m from outside contaminants. Derma Sciences 1" x 5 yards SDR-0019 Sterile Packing Plain 1" (Bottle) PAK-ITS Y 2 (Bottles not for use at clinic - See single use packs below). DUP59320 2.54cm x 4.5m Derma Sciences 2" x 36" SDR-0022 Sterile Gauze Packing Cotton 2x36" PAK-ITS Y 3 DUP564036 5 cm x 90 cm Derma Sciences 1/4" x 36" SDR-0088 Sterile Gauze Packing Cotton Single Use 1/4" PAK-ITS Y 3 DUP561036 0.64 x 90cm Derma Sciences 1/2" x 54" SDR-0089 Sterile Gauze Packing Cotton Single Use 1/2" PAK-ITS Y 3 DUP4853 1.3 x 137cm Derma Sciences 2" x 54" SDR-0090 Sterile Gauze Packing Cotton Single Use 2" PAK-ITS Y 3 DUP59420 5 cm x 4.5m Derma Sciences 2" x 72" SDR-0023 Sterile Gauze Packing Cotton Fan Folded 2x72" PAK-ITS Y 3 DUP4869 5 cm x 182 cm Sponge Synthetic Sterile Non-Woven 2"x2" (2 per Derma Sciences 2" x 2" 14 SDR-0064 DuSoft Y Synthetic, 4 Ply, Pack of 2 Pack) DUP84122 5 x 5 cm Packs of 2 Sponge Synthetic Sterile Non-Woven 4"x4" (2 per Derma Sciences 4" x 4" 14 SDR-0065 DuSoft Y Synthetic, 4 Ply, Pack of 2 Pack) DUP84144 10 x 10cm Packs of 2 Derma Sciences 4" x 4" 1 Pack of SDR-0076 Sponge Synthetic Non-sterile Non-Woven 4"x4" DuSoft Y Synthetic, 4 Ply, Pack of 200 DUP94144 10.2 x 10.2 cm 200 TRACHEOTOMY / DRAIN SPONGES: An added fenestration makes these sterile sponges with pre-cut notches ideal for dressing around a tracheostomy tube or any type of tube, IV line/PICC line. Available in a soft 6 ply non-woven or in standard 12 ply gauze. The non-woven sponges provide superior absorption and are low-linting, fast-wicking, and non-adherent to wound beds. The woven gauze sponges are ideal for when natural breathability is desired. Does not contain natural rubber latex. Drain Gauze Sponge Tracheostomy Sterile Derma Sciences 4" x 4" SDR-0055 Ducare Y 14 Woven Cotton, 12 Ply, Pack of 1 Woven 4"x4" DUP82910 10 x 10cm Derma Sciences 4" x 4" 14 SDR-0058 Drain Sponge Sterile Non-woven 4x4 DuSoft Y 6 Ply Non-woven, Pack of 2 DUP84916 10 x 10cm Packs of 2 Derma Sciences 2" x 2" 14 SOT-0036 Drain Sponge Sterile Non-woven 2x2 DuSoft Y 6 Ply Non-woven, Pack of 2 DUP84918 5 x 5 cm Packs of 2

TAPES & SECUREMENT: Medical and surgical tapes used as a securement aid in dressing or tubings (NG, IV, Foley, etc.). Non Allergenic Self-Adhesive Dressing Retention Derma Sciences 2" x 1 yrd A non-sterile and non-woven fixative tape that is breathable and gentle SDR-0039 Ultrafix Y 7 m Tape 2" DUP62036 5 cm x 1 m to the skin. Custom cut by metre lengths Non Allergenic Self-Adhesive Dressing Retention Derma Sciences 4" x 1 yrd A non-sterile and non-woven fixative tape that is breathable and gentle SDR-0040 Ultrafix Y 7 m Tape 4" DUP62037 10 cm x 1 m to the skin. Custom cut by metre lengths

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 9 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Max Derma Sciences SDR-0048 Montgomery Straps and Ties Montgomery 18 cm x 28 cm Y 1 Non-sterile, non-woven DUP97991 primasure priMED Medical 1" x 1.5 yard SDR-0086 White Surgical Tape 1" Single Use Roll Y 1 Universal hypoallergenic tape can be used for all applications. Connect PM5-970201 2.5 cm x 1.4 m primasure priMED Medical 1" x 54" Only order for patients with very fragile at risk skin who react to SDR- SDR-0087 Blue Silicone Tape 1" Single Use Roll Y 1 Comfort PM5-940201 2.5 cm x 1.3m 0086 1" White Surgical Tape priMED Medical 1/2" x 4" SDR-0037 Wound Closure Strip 1/2" (6 Strips) Sterile Primaflex Y 2 Packs 6 Strips per pack PM3-71241 12 x 100 mm priMED Medical 1/4" x 3" SDR-0038 Wound Closure Strip 1/4" (3 Strips) Sterile Primaflex Y 2 Packs 3 Strips per pack PM3-71431 6 x 75 mm BANDAGES & WRAPS: Materials that are dry woven or non-woven and may stretch and conform to body contours. Fabric composition may include cotton, polyester, rayon or nylon. They function for cleansing, packing or to provide absorption as a second layer or dressing, to hold a wound cover in place, to apply pressure or to cushion a wound. Some are sterile or non-sterile in bulk and may be adhesive. Other uses include securing IVs and splints and providing mild compression/support for strains, sprains and edema. Tubular Net Elastic Bandage - Medline Elastic 7 2/3" Non-adhesive and holds dressing/devices securely in place while SDR-0027 NONNET02 Y 2 x 1 metre Fingers/Toes/Small Wrist Net 19.5 cm allowing freedom of movement. Medline Elastic 9 1/3" Non-adhesive and holds dressing/devices securely in place while SDR-0083 Tubular Net Elastic Bandage - Wrist & Elbow NONNET03 Y 2 x 1 metre Net 23.7 cm allowing freedom of movement. Medline Elastic 11 2/3" Non-adhesive and holds dressing/devices securely in place while SDR-0028 Tubular Net Elastic Bandage - Elbow & Arm NONNET04 Y 2 x 1 metre Net 29.6 cm allowing freedom of movement. Medline Elastic 12 3/8" Non-adhesive and holds dressing/devices securely in place while SDR-0029 Tubular Net Elastic Bandage - Knee & Thigh NONNET05 Y 2 x 1 metre Net 31.4 cm allowing freedom of movement. Tubular Net Elastic Bandage - Shoulder Hip Medline Elastic 17" Non-adhesive and holds dressing/devices securely in place while SDR-0084 NONNET06 Y 2 x 1 metre Thigh Net 61 cm allowing freedom of movement. Tubular Net Elastic Bandage - Chest Back Medline Elastic 28 2/3" Non-adhesive and holds dressing/devices securely in place while SDR-0030 NONNET07 Y 2 x 1 metre Perineum Axilla Net 72.8 cm allowing freedom of movement. Tubular Net Elastic Bandage - Chest Region Medline Elastic 31 1/3" Non-adhesive and holds dressing/devices securely in place while SDR-0085 NONNET08 Y 2 x 1 metre Large Net 79.6 cm allowing freedom of movement. Medline Elastic 35" SDR-0031 Tubular Net Elastic Bandage - Chest Region XL NONNET09 Y 2 x 1 metre Non-adhesive and holds dressing/devices securely in place while Net 88.9 cm allowing freedom of movement. SPECIAL ORDER ITEM - May take up Medline Elastic 41" SDR-0035 Tubular Net Elastic Bandage - Chest Region XXL NONNET10 Y 2 x 1 metre to 5 days for stock. Net 93.1 cm Covidien SCM-0003 Mesh Pants XL / XXL Wings 40"-56" Y 1 707A Mesh pants are only authorized only for patients requiring this product Covidien as a means of containing wound care dressings to coccyx, perineal SCM-0004 Mesh Pants Large / XL Wings 32"-42" Y 1 706A area, etc. The NE LHIN does not provide incontinence supplies as per Covidien policy. SCM-0005 Mesh Pants Small / Medium Wings 22"-32" Y 1 705A

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 10 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Max Cardinal SDR-0068 Multipurpose Tubular Elastic Bandage Size C Reliamed 2.75" x 36" Y 2 ZG275TB - Limb sizes C through G available. Other sizes may available only as Cardinal an exception item special order with approval. Sizes intended as a SDR-0069 Multipurpose Tubular Elastic Bandage Size D Reliamed 3" x 36" Y 2 ZG30TB guideline only and should be used in conjunction with existing clinical protocols that consider physiological state and wound and skin Cardinal SDR-0070 Multipurpose Tubular Elastic Bandage Size E Reliamed 3.5" x 36" Y 2 condition. ZG35TB - Order in 1 yard lengths (36") Cardinal SDR-0071 Multipurpose Tubular Elastic Bandage Size F Reliamed 4" x 36" Y 2 - If overlapped, applies pressure of 10-15 mm Hg ZG40TB - Can be washed (gentle cycle & air dry) and reused multiple times Cardinal - Contains latex SDR-0072 Multipurpose Tubular Elastic Bandage Size G Reliamed 4.5" x 36" Y 2 ZG45TB Derma Sciences SVS-0003 High Stretch Elastic Bandage Non-Latex 4" Dusor 4" x 5 yards Y 1* *May order 2 for initial order only if needed. Non-Sterile DUP71414LF Derma Sciences SVS-0004 High Stretch Elastic Bandage Non Latex 6" Dusor 6" x 5 yards Y 1* *May order 2 for initial order only if needed. Non-Sterile DUP71416LF

COMPRESSION WRAPS: Short Stretch multi-layer elastic stretch bandage system with limited extensibility (less than 100%) for use to provide moderate to high compression 2 Rolls - Comfort layer and compression layer. Ideal for majority of 3M SVS-0006 2 Layer Compression System - 35-40mmHg Coban 2 Each Y 2 patients with venous leg ulcers, lymphedema and other conditions 2094 where compression bandage therapy is appropriate. 3M 2 Rolls - Comfort layer and compression layer. Designed to be more SVS-0007 2 Layer Compression System - 25-30 mmHg Coban 2 Lite Each Y 2 2794 comfortable for patients less tolerant of compression bandages.

OTHER & SPECIALTY: NE LHIN does not provide incontenance supplies. This product is Cardinal authorized for patients for containment of drainage or for methotrexate SCM-0019 Blue Absorbent Pad 23"x24" Cardinal Health 23" x 24" Y 1/Visit UPSMD2324 administration in-home/clinic ONLY. Approved clinics may order in bulk.

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 11 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Max DRESSING KITS: CHS Y 1 For catheter treatments only (PNT or PICC). Not for use in wound care. SDR-0005 Dressing Tray Kit - Disposable Single Use MED-Rx Each Kit 85-4009 3 Compartment 1200 CC Outer Tray 1

Rayon Cotton Balls Large Absorbent 6

Gauze 4" x 4" - 8 Ply 4

4" Plastic Transfer Forcep 3

Absorbent Towel - 3 Ply 1

CSR Sterile Field Towel 1

Waste Bag with Tie 1

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 12 of 54 North East LHIN Home & Community Care Regional Approved Medical Supplies List

WOUND CARE

Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Max ABSORPTIVES: Multi-layer wound covers that provide either a semi-adherent quality or a non-adherent layer, combined with highly absorptive layers of fibers, such as cellulose, cotton or rayon. Designed to minimize adherence to the wound and manage exudate. They may be used as a primary or secondary dressing to manage surgical incisions, lacerations, abrasions, burns, donor or skin graft sites, or any exudating wound. Mölnlycke 4" x 6" SWC-0107 Absorbent Dressing 4"x6" Mesorb Y 7 677201 10 x 15 cm Mölnlycke 6" x 8" SWC-0108 Absorbent Dressing 6"x8" Mesorb Y 7 677601 15 x 20 cm Mölnlycke 8" x 12" SWC-0109 Absorbent Dressing 8"x12" Mesorb Y 7 677801 20 x 30 cm Mextra Super- Mölnlycke 4" x 6" SWC-0142 Super-Absorbent Dressing 4"x6" Y 4 absorbent 610100 10 x 15 cm - For best result, the pad should overlap the dry surrounding skin by at least 2 cm. Mextra Super- Mölnlycke 6" x 8" SWC-0143 Super-Absorbent Dressing 6"x8" Y 4 - May be left in place for several days. The dressing absorbent 610300 15 x 20 cm should be changed according to the clinical Mextra Super- Mölnlycke 8" x 12" SWC-0144 Super-Absorbent Dressing 8"x12" Y 4 condition of the wound, or when saturated. absorbent 610500 20 x 30 cm GELLING FIBER & ANTIMICROBIAL SILVER GELLING FIBER DRESSINGS: The products have a "primary mode of action" to absorb wound exudate and maintain a moist wound environment • Converts to a solid gel when activated by moisture • Includes synthetic gelling fiber dressings with and without silver antimicrobial properties • Supports autolytic debridement • Best for moderate amounts of exudate • Should not be used on dry wounds. ConvaTec 4" x 4" SWC-0150 Gelling Fiber Dressing 4"x4" Aquacel Extra Y 4 420672 10 x 10 cm ConvaTec 6" x 6" SWC-0151 Gelling Fiber Dressing 6"x6" Aquacel Extra Y 4 420673 15 x 15 cm ConvaTec 1" x 18" SWC-0106 Gelling Fiber Ribbon 1"x18" Aquacel Y 4 403770 2 x 45 cm Aquacel Ag ConvaTec 4" x 4" SWC-0152 Gelling Fiber Antimicrobial Silver Dressing 4"x4" Y 4 Extra 420676 10 x 10 cm Gelling Fiber Antimicrobial Silver Dressing Aquacel Ag ConvaTec 8" x 12" SWC-0153 Y 4 8"x12" Extra 420679 19 x 29 cm Gelling Fiber Antimicrobial Silver Impregnated ConvaTec 1" x 18" SWC-0032 Aquacel Ag Y 4 Ionic Silver Ribbon 1"x18" 403771 2 x 45 cm

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 13 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Max ALGINATES & ANTIMICROBIAL SILVER ALGINATE DRESSINGS: Non-woven, non-adhesive pads and ribbons composed of seaweed derivatives • Indicated for wounds with moderate to heavy exudate, such as pressure ulcers, infected wounds, diabetic ulcers and venous insufficiency ulcers • Has hemostatic capabilities • Requires a secondary dressing • Should not be used on dry wounds • Lower tensile strength – care needed when packing into narrow deep sinuses • Autolytic debridement of sloughy wounds Nu-Derm KCI Medical 4" x 4" SWC-0036 Alginate Dressing 4"x4" Y 3 Alginate AWD404 10 x 10 cm KCI Medical 4.3" x 4.3" SWC-0120 Antimicrobial Silver Alginate Dressing Silvercel Y 3 CAD011 11 x 11 cm KCI Medical SWC-0154 Antimicrobial Silver Rope Alginate Dressing Silvercel 2.5 x 30.5cm Y 3 CAD7230 ANTIMICROBIALS & SILVER: Broad spectrum topical antimicrobials to reduce localized bacteria. Indicated to help reduce the risk of infection in partial- and full-thickness wounds, over percutaneous line sites and surgical incisions, or around tracheostomies. The ability to handle exudate depends on the characteristics and composition of the product. Does not replace systemic antibiotics for deeper tissue infections. Not to be used if known hypersensitivities to any product components.

For adjunctive treatment and prevention of infection Non-adherent Antiseptic Impregnated Gauze Smith & Nephew 4" x 4" SWC-0034 Bactigras Y 4 in skin loss lesions, including wounds, burns and 4"x4" 66003650 10 x 10 cm ulcers

Cadexomer Iodine should not be used in patients Smith & Nephew 10 Gram SSP-0003 Ointment with Iodine 10Gr Tube Iodasorb Y 1 with known or suspected Iodine sensitivity, history of 66060630 Tube any thyroid disorder, or pregnant or lactating women

KCI Medical 2" x 2" 10% Povidone Iodine; equivalent to 1.0% available SDR-0078 Non-adhesive Povidone-Iodine Dressing 2"x2" Inadine Y 3 P01481 5 x 5 cm iodine

Non-adhesive Povidone-Iodine Dressing KCI Medical 3.75 x 3.75" 10% Povidone Iodine; equivalent to 1.0% available SDR-0079 Inadine Y 3 3.75"x3.75" P01512 9.5 x 9.5 cm iodine

Silver Antimicrobial Barrier Dressing Non- Acticoat Smith & Nephew 4" x 4" Not compatible with oil-based products, such as SWC-0119 Y 3 Absorbent 4"x4" Flex 3 66800399 10 x 10cm petrolatum

Up to 7 day wear time. Not to be ordered with Acticoat Smith & Nephew 4" x 5" SWC-0156 Antimicrobial Silver Mesh Y 1 dressing changes more frequently than Q3. Can be Flex 7 66800397 10 x 12.5cm cut to fit.

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 14 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Max Covidien 4" x 4" SWC-0112 PHMB Antimicrobial Non-Woven Sponges 4"x4" Kendall Y 7 Impregnated with 0.2% PHMB 8044AMD 10.1 x 10.1 cm Impregnated with 0.2% PHMB; 12 Ply Covidien 4" x 4" SWC-0010 PHMB Antimicrobial Gauze Square 4"x4" Curity Y 7 If on backorder, this will be automatically substituted 2533 10.2 x 10.2 cm with SWC-0112 (Product 8044AMD) Covidien 4.5" x 4 1/8 yd SWC-0113 PHMB Antimicrobial Gauze Roll 4.5" Kerlix Y 7 Impregnated with 0.2% PHMB; 6 Ply 3332 11.4cm x 3.7m Covidien 1/4" x 36" SWC-0115 Antimicrobial Gauze PHMB Ribbon 1/4" x 1 yard Curity Y 7 Impregnated with 0.2% PHMB 7831AMD 0.6 x 91.4 cm Covidien 1/2" x 36" SWC-0116 Antimicrobial Gauze PHMB Ribbon 1/2" x 1 yard Curity Y 7 Impregnated with 0.2% PHMB 7832AMD 1.3 x 91.4 cm Covidien 1" x 36" SWC-0117 Antimicrobial Gauze PHMB Ribbon 1" x 1 yard Curity Y 7 Impregnated with 0.2% PHMB 7833AMD 2.5 x 91.4 cm Antimicrobial Gentian Violet Methylene Blue Hollister 4" x 4" SWC-0118 Hydrofera Blue Y 3 Dressing 4x4" HB4414 10 x 10 cm Antimicrobial Gentian Violet Methylene Blue Hollister 6" x 6" SWC-0137 Hydrofera Blue Y 3 Dressing 6x6" HB6614 15 x 15 cm Pre-moistened; No cover dressing required; Rapid Antimicrobial Gentian Violet Methylene Blue Hydrofera Blue Hollister 4" x 5" SWC-0155 Y 1 wicking and exudate retention; Up to 7 day wear Moist Foam Dressing 4x5" Ready HBRS4520 10 x 12.5cm time. Antimicrobial Gentian Violet Methylene Blue Hollister 9 mm SWC-0138 Hydrofera Blue Y 3 Tunneling Dressing 6x6" HBT0906 (Pack of 2)

Medline As SWC-0131 Antimicrobial Gel with Silver 0.25 oz SilvaSorb 0.25 oz Tube Y For clinic patients only MSC93025EP required

Medline SWC-0132 Antimicrobial Gel with Silver 1.5 oz SilvaSorb 1.5 oz Tube Y 1 Community patients - not clinic MSC9301EP

Textile Antimicrobial Silver (Custom order by 12" Coloplast 10" x Custom Moisture-wicking fabric. Custom order per 12" SWC-0134 InterDry AG Y 4 lengths) 7910 12" lengths lengths

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 15 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Max

Coloplast 4" x 4" SWC-0157 Foam Silver Dressing Biatain AG Y 4 Non-adhesive 9622 10 x 10 cm

Wound Specialists/ET/NPs Only. Cleanses, fills, PolyMem 4.25" X 4.25" SWC-0145 Silver Non-Adhesive Pad Dressing 1044 N 2 absorbs and moistens wounds. Combined Silver 10.8 x 10.8 cm primary/secondary dressing or as a secondary dressing. Can be cut to size.

PolyMem MAX 4" X 4" MAX is a thicker PolyMem configuration for wounds SWC-0146 Silver Non-Adhesive Pad Dressing (MAX) 1045 N 2 Silver 10 x 10 cm with heavier drainage or when longer wear time is desired.

COMPOSITE & MULTIFUNCION DRESSINGS: Multilayered, combination dressings to provide multiple functions, such as a bacterial barrier, absorption and adhesion. Usually, they are comprised of multiple layers and incorporate a semi- or non-adherent pad that covers the wound. Some are appropriate for autolysis. May also include an adhesive border of non-woven fabric tape or transparent film. Composite dressings can function as either a primary or a secondary dressing on a wide variety of wounds and may be used with topical medications. Use with wounds that have moderate to large amounts of exudate.

- Wound Specialists/ET/NPs Only. Cleanses, fills, 4" x 4" SWC-0147 Non-Adhesive Pad Dressing PolyMem 5044 N 2 absorbs and moistens wounds. Combined 10 x 10 cm primary/secondary dressing or as a secondary dressing. Can be cut to size. - MAX is a thicker PolyMem configuration for 4.25" x 4.25" SWC-0148 Non-Adhesive Pad Dressing (MAX) PolyMem MAX 5045 N 2 wounds with heavier drainage or when longer wear 10.8 x 10.8 cm time is desired. SWC-0090 Protease inhibitor dressing with Collagen (‡) Promogran KCI 28 cm2 Y 2 Contraindicated for: Malignant wounds, Eschar in M772028 Hexagonal wounds, Untreated Wound Infection, Wounds less than 12 weeks old, Diabetic Ulcer not offloaded/uncontrolled diabetes – HbA1C more than 7.9%, Pressure Ulcer not offloaded, Extensive burns, Hypersensitivity, Acute vasculitis and Venous 2 SWC-0158 Protease inhibitor dressing with Silver (‡) Promogran KCI 28 cm Y 2 Ulcer not in a compression system of at least Prisma PS2028 Hexagonal 20mmHg Protease Inhibitor should be discontinued if there is no progression towards wound healing (less than 10% healing in 3 weeks).

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 16 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Max SVS-0008 Non-Elastic Zinc Paste Bandage Primer Derma Sciences 7.6 cm x 9 m Y 2 A gauze bandage that has been evenly impregnated GL300-1 with a non-hardening paste of zinc oxide. Ideal for managing: venous ulcers, lymphaticedema, minor sprains, strains, fractures and thrombophlebitis. Contains no gelatin which prevents the hardening or caking of the bandage. Made without preservatives and with non-raveling thread locked gauze.

CLEAR ACRYLIC DRESSINGS: Transparent film contact layer and clear, acrylic polymer pad, topped with breathable, waterproof film. Enables clinicians to monitor small to moderately exuding wounds without changing the dressing • Supports autolytic debridement • Extended wear time • Skin graft donor sites • Skin tears and pre-tibial lacerations • Post-operative wounds • First (superficial thickness) and second (partial thickness) degree burns and abrasions • Do not cut acrylic pad

3M 3 in. x 3-3/4 in. SWC-0139 Absorbent Clear Acrylic Small Oval 7.6x9.5cm Tegaderm Y 1 90800 7.6 x 9.5 cm For pressure ulcers, skin tears and other low to moderately exuding wounds. Dressing should 3M 4-3/8 in. x 5 in. overlap the wound margins by at least 3/8" (1 cm). SWC-0140 Absorbent Clear Acrylic Medium Oval 11x12cm Tegaderm Y 1 90801 11.1 x 12.7 cm

FOAMS: Foam dressings are sheets and other shapes of foamed polymer solutions (most commonly polyurethane) with small, open cells capable of holding fluids. They may be impregnated or layered in combination with other materials. Absorption capability depends on thickness and composition. The area in contact with the wound surface is non-adhesive for easy removal. Available with an adhesive border and/or a transparent film coating that acts as a bacterial barrier. Indicated for partial- and full-thickness wounds. Used on lightly- to heavily-exudating wounds, depending on product. Occlusive foams without silver should not be used on infected wounds. Mölnlycke 4" x 4" SWC-0099 Foam Non-Border 4"x4" Mepilex XT Y 4 211100 10 x 10 cm Mölnlycke 8" x 8" SWC-0100 Foam Non-Border 8"x8" Mepilex XT Y 4 211400 20 x 20 cm Mölnlycke 6" x 6" SWC-0101 Foam Non-Border Soft Silicone 6"x6" Mepilex Lite Y 4 284300 15 x 15 cm Mölnlycke 3 "x 3" SWC-0102 Foam Border Silicone 3"x3" Mepilex Border Y 4 295200 7.5 x 7.5 cm Mölnlycke 4" x 4" SWC-0103 Foam Border Silicone 4"x4" Mepilex Border Y 4 295300 10 x 10 cm Mölnlycke 6" x 6" SWC-0104 Foam Border Silicone 6"x6" Mepilex Border Y 4 295400 15 x 15 cm Mepilex Border Mölnlycke 4" x 4" SWC-0105 Foam Border Silicone 4"x4" Y 4 Lite 281300 10 x 10 cm

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 17 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Max Coloplast 4" x 4" SWC-0129 Foam Non-Adhesive with Ibuprofen 4"x4" Biatain IBU Y 4 4110 10 x 10 cm

Coloplast 6" x 6" SWC-0130 Foam Non-Adhesive with Ibuprofen 6"x6" Biatain IBU Y 4 4115 15 x 15 cm

HYDROCOLLOIDS: Wafers, powders or pastes composed of gelatin, pectin or carboxymethylcellulose. Moisture-retentive dressing, contributes to autolytic debridement. Creates occlusive barrier against bacterial invasion. Absorption capability depends on thickness and composition. Useful on areas that require contouring, such as heels and sacral ulcers. Indicated for partial- and full-thickness wounds with or without necrotic tissue. Characteristic odour may accompany dressing change and should not be confused with infection. Caution when used on fragile skin and should not be used on heavily draining or infected wounds. Coloplast 4" x 4" SWC-0051 Hydrocolloid Regular Square 4x4" Comfeel Plus Y 3 33110 10 x 10 cm Coloplast 6" x 6" SWC-0052 Hydrocolloid Regular Square 6x6" Comfeel Plus Y 3 33115 15 x 15 cm Coloplast 8" x 8" SWC-0080 Hydrocolloid Regular 8"x8" Comfeel Plus Y 3 33120 20 x 20 cm Coloplast 7" x 8" SWC-0056 Hydrocolloid Regular Sacral Comfeel Plus Y 3 33285 18 x 20 cm Comfeel Plus Coloplast 4" x 4" SWC-0045 Hydrocolloid Transparent Square 4x4" Y 3 Transparent 33533 10 x 10 cm Comfeel Plus Coloplast 6" x 6" SWC-0048 Hydrocolloid Transparent Square 6x6" Y 3 Transparent 33539 15 x 15 cm Comfeel Plus Coloplast 3.5" x 5.5" SWC-0047 Hydrocolloid Transparent Rectangle 3.5x5.5" Y 3 Transparent 33536 9 cm x 14 cm Comfeel Plus Coloplast 3.5" x 4" SWC-0053 Hydrocolloid Transparent Oval Y 3 Transparent 33283 9 x 11 cm HYDROGEL: Polymers with high water content designed to absorb a small amount of exudate, prevent drying of the wound bed and maintain a moist healing environment. The high moisture content serves to rehydrate wound tissue. Available in gels, solid sheets or embedded into gauze. Can decrease pain. Indicated for partial and full-thickness wounds, wounds with necrosis, minor burns and radiation tissue damage. May require a secondary dressing. Solid sheets should not be used on infected wounds.

Smith & Nephew SWC-0023 Hydrogel (Low Pectin, Low Saline) Intrasite Gel 15 g Y 3 7311

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 18 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Max FILMS & MEMBRANES: Transparent film dressings are polymer membranes of varying thickness coated on one side with an adhesive. They are impermeable to liquid, water and bacteria but permeable to moisture vapor and atmospheric gases. Moisture vapour transmission rate (MVTR) varies from film to film. Can help reduce friction to susceptible skin (e.g. heels). Transparency allows visualization of the wound. Indicated for partial-thickness wounds with little or no exudate, wounds with necrosis, and as both a primary or secondary dressing. Also used to cover IV sites, donor sites, lacerations, abrasions and second- degree burns. Available in a wide variety of sizes, both sterile and in bulk. Should not be used on draining or infected wounds. 3M 4" x 4.75" SWC-0072 Transparent Film Dressing 10x12cm Tegaderm Y 3 1626W 10 x 12 cm 3M 6" x 8" SWC-0128 Transparent Film Dressing 15x20cm Tegaderm Y 3 1628 15 x 20 cm 3M 1 Roll cut in 1 meter lengths per patient order. LHIN SWC-0159 Transparent Film Dressing 10cm x 1m Tegaderm 10 cm x 1 m Y 16004 Meter staff NPs and ETs may order an entire 10m roll.

ODOUR ABSORBENT DRESSINGS: Odour absorbent charcoal contained within product that masks the odour. Ensure that dressing edges are sealed to control odour and treat the cause if possible.

Actisorb Plus KCI Systagenix 4" x 4" SWC-0037 Activated Charcoal Dressing with Silver 4"x4" Y 2 Silver 220 MAS105 10.5 x 10.5 cm Silver is not released into the wound, so can be use on silver-sensitive patients. Remains effective to Activated Charcoal Dressing with Silver 2.5 x Actisorb Plus KCI Systagenix 2.5" x 3.75" SWC-0135 Y 2 reduce odour when wet or dry and can be left in 3.75" Silver 220 MAS065 6.5 x 9.5 cm place for up to 7 days. NOTE: This product should Actisorb Plus KCI Systagenix 4" x 7.5" SWC-0136 Activated Charcoal Dressing with Silver 4" x 7.5" Y 2 not be cut Silver 220 MAS190 10.5 x 19 cm NON-ADHERENT: Porous sheets of dressings with low adherence to tissue. Serves as a contact layer that allows the transfer of exudate to secondary dressing. May be composed of silicone or tulles. Facilitates application of topical preparations. Use with wounds that are painful or friable. May require a secondary dressing.

Systagenix 3" x 3" SWC-0003 Non Adherent Sterile Impregnated Gauze 3"x3" Adaptic Y 4 2012 7.6 x 7.6 cm

Systagenix 3" x 8" SWC-0076 Non Adherent Sterile Impregnated Gauze 3"x8" Adaptic Y 7 2015 7.6 x 20.3 cm

Mölnlycke 3"x 4" SWC-0160 Non Adherent Sterile Silicone Dressing 3"x4" Mepitel Y 3 290710 7.5 x 10 cm

Smith & Nephew 4"x4" SWC-0086 Non Adherent Sterile Impregnated Gauze 4"x4" Jelonet Y 4 7404 10 x 10 cm

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 19 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Max OTHER & SPECIALTY:

Primary mode of action to maintain a moist wound 1 Tube Coloplast environment, wound debridement and absorbing SWC-0161 Hydrophilic Wound Paste Triad 71 g Tube Y every 1964 wound exudate. Sterile and composed zinc oxide 2 weeks paste

In- Home: CHS SDR-0011 Sterile Single Use Scissors MED-Rx 4 1/2" Y 1/Week Sharp/Blunt 85-4202 Clinic: 1 / Visit In- Home: CHS SDR-0012 Sterile Plastic Thumb Forceps MED-Rx Each Y 3/ Week 85-4200 Clinic: 1 / Visit

Medline Medline SDR-0025 Skin Staple Remover Each Y 1 Single use; Sterile; Tweezer Style Canada DYNJ04058

MED-RX SDR-0062 Wound irrigation tip for syringe MED-RX 1 Tip Y 7 Single use. Syringe must be ordered separately 20-1104

CHS 1 x 2 teeth For sharp/surgical debridement and should only be SDR-0080 Tissue Forceps Metal Sterile Disposable MED-Rx Y 1/Visit 85-9000 4-3/4" performed by clinicians with this expertise.

CHS For sharp/surgical debridement and should only be SDR-0081 Curved Iris Scissors Sterile MED-Rx 4 1/2" Y 1/Visit 85-9411 performed by clinicians with this expertise

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 20 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Max

BD BBL BD SWC-0059 Wound Culture Swab Each Y 1 Culture Swab 220105

Integra Sharp/surgical debridement should only be SWC-0064 Single Use Safety Scalpel - Size 10 Miltex Size 10 Y 3 4-510 performed by clinicians with this expertise.

Flexible Silver Nitrate Caustic 6" Applicator Stick AMG Medical SWC-0066 AMG Each Y 3 Silver Nitrate 75%, Potassium Nitrate 25% (3) 118-395

Flexible Silver Nitrate Caustic 6" Applicator Stick AMG Medical SWC-0141 AMG Pack of 100 N 1 For approved ETs nurses and clinic bulk orders only. (100 pack for Clinic) 118-395

Helps reduce friction during removal of tapes and Smith & Nephew Each films. Can also be used to prepare skin attachment SWC-0121 No-Sting Barrier Wipe Single Use Skin-Prep Y 3 59420600 1 mL Wipe sites for drainage tubes, external catheters, surrounding ostomy sites and adhesive dressings.

For sharp/surgical debridement and should only be SWC-0122 Dermal Curette with 4mm tip Miltex Integra 33-54 Each Y 1 performed by clinicians with this expertise.

SDR-0006 Cotton Tipped Applicator Plastic Sterile 2/pk Medline MDS202095 1 Pack of 2 Y 7

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 21 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Max

SDR-0010 Sterile Tongue Depressor AMG Medical 118-421 Adult Y 3 Adult size Individually wrapped, single patient use.

WOUND CARE KITS: Prepared kits of commonly used items. Most items in each kit can be ordered individually if an entire kit is not required if an individual LHIN code is listed below. Additional items may also be ordered as needed.

Medline Medline Single patient use; Sterile, includes Wire Forceps, SDR-0024 Suture Removal Kit Each Y 1 Canada DYNDCA1002A Gauze, Sponge and Scissors

Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Max Y 1 Maximum Quantity: 1 Kit/Patient Admission SMK-0042 Initial Wound Care Kit: N/A Various Each Kit Start up kit only. Visiting Nurse to identify and order SDR-0039 Non Allergenic Self-Adhesive Dressing Retention Tape 2" 1 regular wound care supplies after initial visit SDR-0064 Sponge Synthetic Sterile Non-Woven 2"x2" (2 per Pack) 4 No need to order for patients receiving first visit in SDR-0065 Sponge Synthetic Sterile Non-Woven 4"x4" (2 per Pack) 4 Sudbury or North Bay ambulatory clinics. NO IMAGE AVAILABLE SDR-0006 Cotton Tipped Applicator Plastic Sterile 2/pk 1

SIV-0084 Syringe Luer Lok 30 mL 1

SDR-0062 Wound irrigation tip for syringe 1

SWC-0107 Absorbent Dressing 4"x6" 2

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 22 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Max Cardinal Health Y 1 Maximum Quantity: 1 Kit/Week SWC-0123 Minor Laceration Tray Kit - Sterile: Busse Each Kit 312-751 Disposable single use Plastic Tray 1 For sharp/surgical debridement and should only be performed by clinicians with this expertise. Gauze Sponges 5

Waterproof Sterile Field 1

Fenestrated Waterproof Drape 1

Absorbent Towels 2

Tissue Forceps 1

Needle Holder 1

Scissors 1

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 23 of 54 North East LHIN Home & Community Care Regional Approved Medical Supplies List

NEGATIVE PRESSURE WOUND THERAPY (NPWT)

Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Max Negative Pressure Wound Therapy (NPWT): A therapeutic technique indicated for the application of continual or intermittent negative pressure wound therapy to an acute or chronic wound. The device may promote wound healing by the removal of fluids, including wound exudates, irrigation fluids, body fluids and infections materials. The therapy involves the controlled application of sub-atmospheric pressure to the local wound environment, using a sealed wound dressing connected to a vacuum pump. Equipment and supplies are time-limited as per approved LHIN policy.

REUSABLE FOAM NPWT: Only to be used when Disposable Single-Use NPWT is not appropriate as determined by the NE LHIN

KCI Continuous or Intermittent Modes, Intensity: Low, Medium, High ETM-1014 Reusable Foam NPWT LHIN-Owned Unit ActiV.A.C. Each Y 340013 12 weeks Pressure Settings: -25 mmHg to -200 mmHg (-3.3 to -26.6 kPa) max / Rental only allowed if LHIN-owned unit is not available. Rental unit will KCI ETM-1010 Reusable Foam NPWT Rental Unit ActiV.A.C. Each Y patient automatically be subsitiuted with LHIN-owned unit when available as 340013 appropriate. KCI SNP-0001 VAC Adhesive Drape V.A.C. 30.5 x 26 cm Y 1 M6275009 KCI SNP-0007 T.R.A.C. Y Connector V.A.C. Each Y 3 Y-connector to connect two or more dressings M6275066 KCI 10 x 7.5 x 3.3 Includes 1 small black foam dressing, 1 adhesive drape,1 SensaTRAC SNP-0008 VAC GranuFoam Standard Dressing Kit Small V.A.C. Y 3 M8275051 cm Pad KCI 18 x 12.5 x 3.3 Includes 1 medium black foam dressing, 2 adhesive drapes,1 SNP-0009 VAC GranuFoam Standard Dressing Kit Medium V.A.C. Y 3 M8275052 cm SensaTRAC Pad KCI 26 x 15 x 3.3 Includes 1 large black foam dressing, 2 adhesive drapes,1 SNP-0010 VAC GranuFoam Standard Dressing Kit Large V.A.C. Y 3 M8275053 cm SensaTRAC Pad Includes 1 large black foam dressing, 5 adhesive drapes,1 KCI 60 x 30 x 1.5 SNP-0066 VAC GranuFoam Standard Dressing Kit XL V.A.C. Y 3 SensaTRAC Pad. SPECIAL ORDER ITEM - May take up to 5 days for M8275065 cm stock. KCI 10 x 7.5 x 3.3 Includes 1 small silver foam dressing, 1 adhesive drape,1 SensaTRAC SNP-0017 VAC GranuFoam Silver Dressing Kit Small V.A.C. Y 3 M8275098 cm Pad KCI 18 x 12.5 x 3.3 Includes 1 medium silver foam dressing, 2 adhesive drapes,1 SNP-0018 VAC Granufoam Silver Dressing Kit Medium V.A.C. Y 3 M8275096 cm SensaTRAC Pad KCI 26 x 15 x 3.3 Includes 1 large silver foam dressing, 2 adhesive drapes,1 SNP-0019 VAC Granufoam Silver Dressing Kit Large V.A.C. Y 3 M8275099 cm SensaTRAC Pad KCI Less adherent material helps promote graft take. Includes 1 small SNP-0020 VAC WhiteFoam Dressing Kit Small V.A.C. 10 x 7.5 x 1 cm Y 3 M8275068 PVA foam dressing, 1 adhesive drape, 1 SensaT.R.A.C. Pad

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 24 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Max KCI Less adherent material helps promote graft take. Includes 1 large PVA SNP-0022 VAC WhiteFoam Dressing Kit Large V.A.C. 10 x 15 x 1 cm Y 3 M8275067 foam dressing,1 adhesive drape, 1 SensaT.R.A.C. Pad KCI SNP-0058 VAC WhiteFoam Small (Foam Only) V.A.C. 10 x 7.5 x 1 cm Y 3 1 polyvinyl alcohol (PVA) foam dressing (10 x 7.5 x 1 cm) M6275033 KCI SNP-0059 VAC WhiteFoam Large (Foam Only) V.A.C. 10 x 15 x 1 cm Y 3 1 polyvinyl alcohol (PVA) foam dressing (10 x 15 x 1 cm) M6275034 KCI Includes 1 small Spiral-cut VAC GranuFoam Dressing, 2 adhesive SNP-0046 VAC Simplace Dressing Kit Small V.A.C. Each Y 3 M8275046 drapes, 1 SensaT.R.A.C. Pad KCI Includes 1 medium Spiral-cut VAC GranuFoam Dressing, 2 adhesive SNP-0048 VAC Simplace Dressing Kit Medium V.A.C. Each Y 3 M8275045 drapes, 1 SensaT.R.A.C. Pad KCI 1 canister with gel, tubing, clamp and connector; May be authorized for SNP-0052 300 mL ActiVAC Canister with Gel V.A.C. Each Y 1 M8275058 more than 1/week if the canister is full. KCI SNP-0060 VAC SensaT.R.A.C. Pad V.A.C. Each Y 1 Includes 1 SensaT.R.A.C. Pad with tubing, clamp and connector M8275057 KCI SNP-0061 T.R.A.C Tubing Cap V.A.C. Each Y 1 Cap to secure end of tubing when not in use M6275069 Each kit includes black foam, bridge dressing; sensa TRAC pad and KCI SNP-0067 VAC GranuFoam Bridge Dressing Kit V.A.C. Each Y 3 adhesive drape. SPECIAL ORDER ITEM - May take up to 5 days for M8275042 stock. Each kit includes black foam, bridge dressing; sensa TRAC pad and KCI SNP-0068 VAC GranuFoam Bridge XG Dressing Kit V.A.C. Each Y 3 adhesive drape. SPECIAL ORDER ITEM - May take up to 5 days for M8275044 stock. DISPOSABLE SINGLE-USE NPWT: Cardinal NPWT PRO is the primary disposable single-use NPWT device, and the NANOVA will only be provided with the approval from a the LHIN Enterostomal Therapy Nurse. 2 per Cardinal Health SNP-0070 NPWT PRO Unit NWPT PRO Each Y Patient One unit provided every 42 days. Power supply included 6708888 Admission 1 per Cardinal Health Only provided if patient loses original power supply provided with unit SNP-0071 NPWT PRO AC Power Supply NWPT PRO Each Y Patient 47-9100 (1 per patient admission if required) Admission Cardinal Health SNP-0072 NPWT PRO 300mL Canister with Gel NWPT PRO 300 mL Y 1 Primary choice 47-4000 Cardinal Health SNP-0073 NPWT PRO 500mL Canister with Gel NWPT PRO 500 mL Y 1 Only order if 300 mL is not enough 47-4500 Cardinal Health SNP-0075 NPWT PRO Black Foam Dressing Kit - Small NWPT PRO 10 x 8 x 3 cm Y 3 Includes 1 Small Foam Dressing; 1 Drape; 1 Transfer pad with tubing 47-1702

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 25 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Max Cardinal Health 20 x 12.5 x 3 q72 hours. Includes 1 Medium Foam Dressing; 2 Drapes; 1 Transfer SNP-0076 NPWT PRO Black Foam Dressing Kit - Medium NWPT PRO Y 3 47-1701 cm pad with tubing Cardinal Health q72 hours. Includes 1 Large Foam Dressing; 2 Drapes; 1 Transfer pad SNP-0077 NPWT PRO Black Foam Dressing Kit - Large NWPT PRO 25 x 15 x 3 cm Y 3 47-1700 with tubing Cardinal Health 58.5 x 33 x 3 q72 hours. Includes 1 XL Foam Dressing; 2 Drapes; 1 Transfer pad SNP-0078 NPWT PRO Black Foam Dressing Kit - XL NWPT PRO Y 3 47-1703 cm with tubing Cardinal Health SNP-0079 NPWT PRO Y-Connector NWPT PRO Each Y 1 47-2500 Cardinal Health 9.5 × 9.5 x .05 SNP-0081 NPWT PRO White Foam Dressing NWPT PRO Y 3 For sensitive wounds/burns/grafts/tunnelling 47-1751 cm Cardinal Health SNP-0082 NPWT PRO Polyurethane Drape NPWT PRO 25.5 x 33 cm Y 2 Regular drape in stock - Same as provided in NPWT Dressing Kits 47-7000 For patients with very sensitive, fragile skin. Hypoallergenic and can NWPT PRO Cardinal Health 14" x 10" SNP-0074 NPWT PRO SensiSkin Drape Y 2 help prevent irritation or maceration. Special Order Only - May take up SensiSkin 47-7100 35 cm x 25 cm to 5 days for stock. Aceilty SNP-0062 Negative Pressure NANOVA NPWT Unit NANOVA Each Unit Y 1/month One unit per month and 3 per patient admission max. NANTU/R6.S Aceilty SNP-0063 NANOVA NPWT Dressing Kit Small (Box of 3) NANOVA 18cm x 14cm Y 1 Dressings plus optional GRANUFOAM™ Wound Filler NANGFS/R6.S Aceilty SNP-0064 NANOVA NPWT Dressing Kit Medium (Box of 3) NANOVA 18cm x 18cm Y 1 Dressings plus optional GRANUFOAM™ Wound Filler NANGFM/R6.S Aceilty SNP-0065 NANOVA NPWT Dressing Kit Large (Box of 3) NANOVA 18cm x 28cm Y 1 Dressings plus optional GRANUFOAM™ Wound Filler NANGFL/R6.S

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 26 of 54 North East LHIN Home & Community Care Regional Approved Medical Supplies List

CLEANSERS & ANTISEPTIC SOLUTIONS

Manufacturer LHIN Code Description Brand Name Size APO Weekly Max Notes Code Cleansers & Antiseptic Solutions 3M Reclosable bottle. Document date opened on bottle and discard SSO-0001 Chlorhexidine 2% Alcohol 70% 500 mL Bottle SoluPrep 500 mL Y 1 103.15 unused product after 30 days Reclosable bottle. Document date opened on bottle and discard SSO-0002 Hydrogen Peroxide 3% 500mL Bottle Swan 189-1000035784 500 mL Y 1 unused product after 7 days Baxter SSO-0019 Normal Saline 500 mL bottle Baxter 500 mL Y 1 The items are approved only for: (‡) JF7633P 1) Immunocomprimised patient (i.e. BMT, Oncology, Organ Transplant Derma Sciences SSO-0023 Normal Saline 118 mL Irrigation Bottle Sterile Derma 118 mL Y 7 patient); (‡) DUP48501N 2) Well water (untreated) or Baxter SSO-0031 Sterile Water 500 mL bottle Baxter 500 mL Y 1 3) Environmental considerations (i.e. concerns of hygiene) (‡) JF7623P 3M Single use antiseptic skin preparation wipe for swabbing sites and SSO-0069 Chlorhexidine 2% Alcohol 70% Wipe SoluPrep Each Y 28 101.06 ports for vascular access catheters. Single use 3M Antiseptic skin preparation swabsticks for maintenance of indwelling SSO-0006 Chlorhexidine 2% Alcohol 70% Swabstick SoluPrep Each Y 8 102.03 vascular access catheters. Single use Loris Single use antiseptic topical skin cleanser prior to an injection SSO-0052 Alcohol 70% Wipe Cardinal 30 x 65 mm Y 28 LP103-03 Medium-sized wipe 70% Isopropyl Alcohol; Single use Loris SSO-0054 Povidone Iodine 10% Wipe Cardinal 30 x 65 mm Y 3 Single use 10% PVP-I antiseptic/germicide prep used for wound LP109-01 clensing or minor invasive procedures, scrapes, cuts or burns. Non- Loris SSO-0067 Povidone Iodine 10% Swabstick (Single) Cardinal 13 x 25 mm Y 8 irritating and virtually non-stinging for better patient comfort. LP109-05 Loris Contraindicated for: • Malignant Wounds • Exposed Bone SSO-0004 Povidone Iodine 10% 115mL Bottle Loris 115 mL Y 2 (‡) LP109-09 • Exposed Tendon • Patient with Extensive Burns SSO-0011 Hygeol 1:20 500 mL N/A N/A 500 mL Y 7 per 2 wks Maximum 14/patient

Miscellaneous Oral Swab sticks Latex-free Plain Untreated Sage Products Hospice SOT-0083 Toothette Box of 250 N Palliative patients only at approved Hospice site - Individually wrapped (Box 250) 5602UT sites only Oral Swab sticks Latex-free Plain Untreated Sage Products SOT-0084 Toothette Pack of 10 Y 2 Palliative patients only at home/in community (10 Pack) 6072

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 27 of 54 North East LHIN Home & Community Care Regional Approved Medical Supplies List

URINARY SUPPLIES

Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Maximum Urinary Supplies: Medical supplies that helps drain urine from the bladder. It is used by some patients who have had urological or gynecological surgery, or who have a condition that makes urination difficult. LHIN-funded supplies may be authorized only while the patient is in need of nursing services. ODSP, social assistance, private insurance, DVA must be accessed as possible sources of funding on a long term basis as per LHIN approved policy. Most commonly used sizes are listed below. All other sizes (including pediatric) and coatings are available for special order only as per the Exception Item process.

FOLEY CATHETERS: 2-way Foley (inflation and drainage) indwelling catheters. For short- or long-term catheter patients, the catheter should be the smallest size diameter that permits good urine flow. If a larger diameter was used to facilitate passage of blood clots, the size can be decreased by 2-4 Fr per catheter change until the optimal size is reached. Likewise, balloon sizes should be small, with 5 mL balloons, reserving the 30 mL only for bleeding episodes, usually postoperatively. Long term catheters (over 1 months use) often changed every 4 weeks. Patients with frequent blockage may need catheter changed every 2-3 weeks or more often. BARD 12 Fr SUR-0001 Foley 2 Way Hydrogel Coated Latex 12Fr 5 mL BARD Canada Y 2/month 226512 5 mL Balloon BARD 14 Fr SUR-0002 Foley 2 Way Hydrogel Coated Latex 14Fr 5 mL BARD Canada Y 2/month 226514 5 mL Balloon BARD 16 Fr SUR-0003 Foley 2 Way Hydrogel Coated Latex 16Fr 5mL BARD Canada Y 2/month 226516 5 mL Balloon BARD 18 Fr SUR-0004 Foley 2 Way Hydrogel Coated Latex 18Fr 5 mL BARD Canada Y 2/month 226518 5 mL Balloon BARD 14 Fr SUR-0014 Foley 2 Way Hydrogel Coated Latex 14Fr 30mL BARD Canada Y 2/month 226614 30 mL Balloon BARD 16 Fr SUR-0015 Foley 2 Way Hydrogel Coated Latex 16Fr 30 mL BARD Canada Y 2/month 226616 30 mL Balloon BARD 18 Fr SUR-0016 Foley 2 Way Hydrogel Coated Latex 18Fr 30 mL BARD Canada Y 2/month 226618 30 mL Balloon BARD 20 Fr SUR-0017 Foley 2 Way Hydrogel Coated Latex 20Fr 30 mL BARD Canada Y 2/month 226620 30 mL Balloon BARD 14 Fr SUR-0116 Foley 2 Way Red Latex Tiemann Coude Tip 14Fr 5 mL BARD Canada Y 2/month For difficult insertions, coude-tip Foley catheters feature a bent tip that 0102L14 5 mL Balloon maneuvers around obstructions leading to the bladder (eg. men with BARD 16 Fr SUR-0117 Foley 2 Way Red Latex Tiemann Coude Tip 16Fr 5 mL BARD Canada Y 2/month enlarged prostate) 0102L16 5 mL Balloon 100% Silicone Medline 12 Fr SUR-0027 Foley 2 Way 100% Silicone 12 Fr 10 mL Y 2/month Foley DYND11500 10 mL Balloon 100% Silicone Medline 14 Fr SUR-0028 Foley 2 Way 100% Silicone 14Fr 10 mL Y 2/month Foley DYND11501 10 mL Balloon

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 28 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Maximum 100% Silicone Medline 16 Fr SUR-0029 Foley 2 Way 100% Silicone 16Fr 10 mL Y 2/month Foley DYND11502 10 mL Balloon 100% Silicone Medline 18 Fr SUR-0030 Foley 2 Way 100% Silicone 18Fr 10 mL Y 2/month Foley DYND11503 10 mL Balloon 100% Silicone Medline 16 Fr SUR-0032 Foley 2 Way 100% Silicone 16Fr 30 mL Y 2/month Foley DYND11532 30 mL Balloon 100% Silicone Medline 18 Fr SUR-0033 Foley 2 Way 100% Silicone 18Fr 30 mL Y 2/month Foley DYND11533 30 mL Balloon 100% Silicone Medline 20 Fr SUR-0034 Foley 2 Way 100% Silicone 20Fr 30 mL Y 2/month Foley DYND11534 30 mL Balloon 14 Fr SUR-0118 Foley 2 Way 100% Silicone Coude Tip 14Fr 10 mL Medline DYND11591 Y 2/month For difficult insertions, coude-tip Foley catheters feature a bent tip that 10 mL Balloon maneuvers around obstructions leading to the bladder (eg. men with 16 Fr SUR-0119 Foley 2 Way 100% Silicone Coude Tip 16Fr Medline DYND11592 Y 2/month enlarged prostate). Latex free 10 mL Balloon INTERMITTENT CATHETERS: Closed system kit designed for sterile intermittent catheterization. All-in-one ready to use self-lubicating catheter and sterile bag set. The unique closed system helps to reduce the risk of urinary tract infections. SpeediCath Coloplast SUR-0112 Female Intermittent Catheter 10 Fr 10 Fr x 9 cm Y 35 Compact Set 28520 SpeediCath Coloplast Bag is directly attached to the catheter as a closed system SUR-0113 Female Intermittent Catheter 12 Fr 12 Fr x 9 cm Y 35 Compact Set 28522 Single patient use - Disposable. SpeediCath Coloplast Available in male and female versions SUR-0114 Female Intermittent Catheter 14 Fr 14 Fr x 9 cm Y 35 Compact Set 28524 Maxiumum 5/day SpeediCath Coloplast 12-18 Fr SUR-0115 Male Intermittent Catheter 12-18 Fr Y 35 Compact Set 28422 30 cm long URINARY DRAINAGE BAGS: Urine drainage bags are used to collect urine by attaching to a catheter. Single patient-use reusable leg bags are for use with Foley Catheters. For long-term catheter users, the bags should be replaced every 5-7 days. Drainage bags with slide valve (instead of twist valve) are available by an approved Exception Item Request for patients with hand/finger dexterity concerns. Leg Bag Kit 600 mL Twist Valve with Straps and 18" Medline 19oz / 600 mL SUR-0085 Medline Y 1 - Bags must be emptied when 1/3 to 1/2 full Tubing DYND12575 18" Tubing - LHIN will provide 2 at admission then 1 / week until discharge. Medline 19 oz / 600 mL SUR-0086 Leg Bag 600 mL Twist Valve with Straps Medline Y 1 - Adjustable straps are included and attached to the leg bag. DYND12574 Each - No longer best practice to change bag for overnight use unless the Medline 32oz / 1100 mL SUR-0089 Leg Bag 1100 mL Twist Valve with Straps Medline Y 1 volume requires this to prevent leakage/overflow DYND12578 Each Single patient-use reusable bag for use with Foley Catheters. Drainage Bag 2000 mL with anti-reflux tower and metal Medline 2000 mL SUR-0090 Medline Y 2/month Larger sized bag often used for patients who are bedridden or end of drain clamp DYND15203 Each life

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 29 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Maximum Medline 18 inches 18" extension tubing can be cut to preferred length to meet patient SUR-0094 Urinary Leg Bag Extension Tubing 18" Medline Y 2/month DYND12550 Each needs With adsjustable elastic strap for waist or leg. SOS-0013 Nephostomy Drainage Bag 600 mL Argon DBAG600 600 mL Y 1 LHIN will provide 2 at admission then 1 / week until discharge.

CATHETER STABILIZATION: Adhesive devices used to stabilize indwelling urinary catheters, reducing catheter movement and minimizing accidental dislodgments Bard SUR-0111 Universal Foley Catheter Stabilization Device StatLock Each Y 2/month Silicone Sutureless Tricot Anchor For Urinary catheters FOL0102 Statlock Universal Plus Catheter Stabilization Device Bard SUR-0104 StatLock 12 - 14 fr Y 2/month Large 12-14 FR VUPD1214 StatLock Universal Plus Catheter Stabilization Device Bard Restricts catheter motion and fits virtually all catheter sizes. SUR-0105 StatLock 10 - 12 fr Y 2/month Medium 10 - 12 FR VUPD1012 For biliary and nephrostomy drainage and peritoneal lavage catheters. StatLock Universal Plus Catheter Stabilization Device Bard SUR-0106 StatLock 6 - 8.5 fr Y 2/month Small 6 - 8.5 FR VUPD68

CATHETER ACCESSORIES: There are various accessories that can be used to assist with either indwelling catheter use or the process of intermittent catheterisation.

Medline Fits securely into funnel end of most Foley catheters; Sterile; SUR-0078 Catheter Plug and Drain Tube Cover Set Medline Each Y 2/month DYND12200 Cover protects connector on drainage bag BD 60 mL Used for flushing/cleaning catheters, gastronomy tubes and other SUR-0110 Syringe Catheter Tip 60 mL BD Y 7 309620 2 oz tip devices Medline Soft, pliable bulb for maximum control of drawn or expelled volume. SUR-0120 Bulb Irrigation Syringe 60 mL Medline 60 mL Y 7 DYND20125 Easy to grip and use with only one hand; Sterile Healthcare Healthcare Plus For use only with Foley catheters. Not required for SpeediCath SUR-0091 Sterile Bacteriostatic Lubricant Water Based 3.5 g pouch Y 2/month Plus 248-LUB-035 lubricated intermittent catherters. MED-Rx SUR-0103 Drainage Tube Universal 1 Way Stopcock MED-Rx 16 inch Y 2/month 10-1210 Simport Fisher Scientific Sterile polypropylene container for collection, transport and storage of SUR-0108 Specimen container 90 mL Y 2 Scientific 360993197 specimens

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 30 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Maximum URINARY KITS: Disposable, Single use prepared kits of commonly used items. Most items in each kit can be ordered individually if an entire kit is not required if an individual LHIN code is listed below. Additional items may also be ordered as needed. CHS For catherter insertion 1/month SUR-0079 Foley Catheter Tray MED-Rx Each Tray Y 2 / Month 85-5050 Order catheters, leg bags or drainage bags seperately CSR Wrap Blue 1 If irrigation required add: Plastic Transfer Forcep 1 SUR-0080 Irrigation Tray Kit with 60 mL Piston Syringe and SSO-0019 Normal Saline 500mL bottle Graduated Basin 1

Gloves Medium (Pair) Non-latex 1

Fenestrated Drape Paper 1

Towel Paper 1

Povidone Iodine Swabstick (3 pack) 2

Lubricant Water Based 1

Foley Catheter Stabilization Device 1

Sterile Water 10 mL Pre-Filled Syringe 1 CHS Disposable, single use SUR-0080 Irrigation Tray Kit with 60 mL Piston Syringe MED-Rx Each Kit Y 1 85-5042 Irrigation Tray 1

500 mL Graduated Container 1

60 mL Piston Irrigation Syringe with Cap 1

Alcohol Prep Pad 1

PVP Prep Pad 1

Underpad 17" x 18" 1

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 31 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Maximum NE LHIN Various - See each Y 1 If an entire kit is not required, you may order any of the items in the kit SMK-0008 Percutaneous Nephrostomy Kit: Each Kit item seperately SDR-0005 Dressing Tray Kit - Disposable Single Use 2 If a drainage bag is required order: SUR-0090 Drainage Bag 2000 mL with anti-reflux tower and metal SDR-0055 Drain Gauze Sponge TrachSterile Woven 4"x4" 2 drain clamp SOT-0001 Disposable Ear Loop Surgical Face \Mask 2 Dressing Tray SDR-0005 may be ordered individually if an entire kit is not required SOT-0021 Sterile Nitrile Gloves Medium (Pair) 2 Order Catheter Stabilization Device seperately SSO-0021 Normal Saline 10 mL Pre-Filled Syringe 1

SSO-0052 Alcohol 70% Wipe 14

SUR-0086 Leg Bag 600 mL Twist Valve with Straps 1

SWC-0128 Transparent Film Dressing 15x20cm 2

SUR-0103 Drainage Tube Universal 1 Way Stopcock 2

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 32 of 54 North East LHIN Home & Community Care Regional Approved Medical Supplies List

OSTOMY SUPPLIES & ACCESSORIES

Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Maximum OSTOMY SUPPLIES & ACCESSORIES: Products such as ostomy pouches, skin barriers and accessories used in the care & management of urostomies, ileostomies and colostomies. Authorization for LHIN-funded supplies as per approved policy and only for short-term treatment to allow patient some time to coordinate private pay options, insurance coverage and ADP applications. Coloplast is the LHIN's primary vendor and therefore Hollister and ConvaTec products require the approval of a LHIN Enterostomal Therapy Nurse. Ostomy Skin Barriers for 2 Piece System: Cut-to-fit flanges (also called "baseplates") that attach directly to the skin. Measure the stoma accurately and select a cut-to-fit barrier opening which fits comfortably around the stoma without actually touching it. Too large an opening will leave skin exposed and could lead to skin irritation. SenSura Mio Coloplast Coupling/Flange SOS-0068 2 Piece Click Barrier Green Flat Cut-to-Fit Y Non-Convexity, Stoma size 10-35mm (3/8"- 1 3/8") Click 10502 40 mm (1 9/16") SenSura Mio Coloplast Coupling/Flange SOS-0025 2 Piece Click Barrier Red Flat Cut-to-Fit Y Non-Convexity, Stoma size 10-45mm (3/8"- 1 3/4") Click 10512 50 mm (2") SenSura Mio Coloplast Coupling/Flange SOS-0026 2 Piece Click Barrier Yellow Flat Cut-to-Fit Y Non-Convexity, Stoma size 10-65mm (3/8"- 2 1/5") Click 10531 70 mm (2 3/4") 2 Piece Click Barrier Green Convex Light Cut-to- SenSura Mio Coloplast Coupling/Flange SOS-0027 Y Light Convexity, Stoma size 10-20mm (3/8"- 3/4") Fit Click 16901 40 mm (1 9/16") SenSura Mio Coloplast Coupling/Flange SOS-0028 2 Piece Click Barrier Red Convex Light Cut-to-Fit Y Light Convexity, Stoma size 15-30mm (5/8"- 1 1/8") Click 16911 50 mm (2") SenSura Mio Coloplast Coupling/Flange SOS-0029 2 Piece Click Barrier Blue Convex Light Cut-to-Fit Y Light Convexity, Stoma size 15-40mm (5/8"- 1 9/16") Click 16921 60 mm (2 3/8") 5 / Week 2 Piece Click Barrier Yellow Convex Light Cut-to- SenSura Mio Coloplast Coupling/Flange SOS-0030 Y Light Convexity, Stoma size 15-53mm (5/8"- 2 1/16") Fit Click 16931 70 mm (2 3/4") Maximum 10 2 Piece Click Barrier Green Convex Deep Cut-to- SenSura Mio Coloplast Coupling/Flange SOS-0031 Y per patient Deep Convexity, Stoma size 10-20mm (3/8"- 3/4") Fit Click 16941 40 mm (1 9/16") admission 2 Piece Click Barrier Red Convex Deep Cut-to- SenSura Mio Coloplast Coupling/Flange SOS-0032 Y of any Deep Convexity, Stoma size 15-30mm (5/8"- 1 1/8") Fit Click 16951 50 mm (2") combination SenSura Mio Coloplast Coupling/Flange SOS-0033 2 Piece Click Barrier BlueConvex Deep Cut-to-Fit Y of sizes Deep Convexity, Stoma size 15-40mm (5/8"- 1 9/16") Click 16961 60 mm (2 3/8") 2 Piece Click Barrier Yellow Convex Deep Cut-to- SenSura Mio Coloplast Coupling/Flange SOS-0034 Y Deep Convexity, Stoma size 15-53mm (5/8"- 2 1/16") Fit Click 16971 70 mm (2 3/4") The following items require approval from LHIN Enterostomal Therapy Nurse: Hollister Coupling/Flange Non-Convexity, Stoma size up to 32mm (1 1/4") SOS-0017 2 Piece Hollister Barrier Green Flat Cut-to-fit CeraPlus N 11202 44 mm (1 3/4") Infused with ceramide to protect peristomal skin Hollister Coupling/Flange Non-Convexity, Stoma size up to 44mm (1 3/4") SOS-0018 2 Piece Hollister Barrier Red Flat Cut-to-fit CeraPlus N 11203 57 mm (2 1/4") Infused with ceramide to protect peristomal skin Hollister Coupling/Flange Convex, Stoma size up to 25mm (1") SOS-0019 2 Piece Hollister Barrier Green Convex Cut-to-fit CeraPlus N 11402 44 mm (1 3/4") Infused with ceramide to protect peristomal skin Hollister Coupling/Flange Convex, Stoma size up to 38mm (1 1/2") SOS-0020 2 Piece Hollister Barrier Red Convex Cut-to-fit CeraPlus N 11403 57 mm (2 1/4") Infused with ceramide to protect peristomal skin

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 33 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Maximum Urostomy Pouches for 2 Piece System: Order with appropriate brand and size Ostomy Skin Barrier A drainable pouch that connects to the barrier flange to collect urine with an integrated drain valve at the bottom to empty the bag.

2 Piece SenSura Mio Click Urostomy Pouch SenSura Mio Coloplast Coupling/Flange SOS-0035 Y Green Click Maxi 11492 40mm (1 9/16") Bag length 26cm (10 1/4"), 5 / Week Transparent SenSura Mio Coloplast Coupling/Flange SOS-0036 2 Piece SenSura Mio Click Urostomy Pouch Red Y Click Maxi 11498 50mm (2") Maximum 10 per patient The following items require approval from LHIN Enterostomal Therapy Nurse: admission of any May only be ordered with the Hollister 2-Piece Hollister Coupling/Flange SOS-0021 2 Piece Hollister Urostomy Pouch Green Hollister Y combination Barrier as approved by LHIN Enterostomal Therapy 18402 44mm (1 3/4") of sizes Nurse:

Bag length 23cm (9") Hollister Coupling/Flange SOS-0022 2 Piece Hollister Urostomy Pouch Red Hollister Y Transparent 18403 57mm (2 1/4") Includes drain tube adaptor Drainable Pouches for 2 Piece System: Order with appropriate brand and size Ostomy Skin Barrier. A drainable pouch with a larger opening for ileostomies and colostomies that connects to the barrier flange. An integrated closure or clamp is used to keep the pouch closed until it requires emptying. 2 Piece SenSura Mio Click Drainable Pouch SenSura Mio Coloplast Coupling/Flange SOS-0037 Y Green Click Maxi 11463 40mm (1 9/16") SenSura Mio Coloplast Coupling/Flange Bag length 28cm (11") SOS-0038 2 Piece SenSura Mio Click Drainable Pouch Red Y Click Maxi 11473 50mm (2") Transparent SenSura Mio Coloplast Coupling/Flange Easiclose™ SOS-0039 2 Piece SenSura Mio Click Drainable Pouch Blue Y Click Maxi 11483 60mm (2 3/8") 5 / Week Wide Outlet 2 Piece SenSura Mio Click Drainable Pouch SenSura Mio Coloplast Coupling/Flange SOS-0040 Y Yellow Click Maxi 11487 70mm (2 3/4") Maximum 10 per patient The following items require approval from LHIN Enterostomal Therapy Nurse: admission of any May only be ordered with the Hollister 2-Piece New Image Hollister Coupling/Flange combination SOS-0023 2 Piece Hollister Drainable Pouch Green N Barrier as approved by LHIN Enterostomal Therapy Lock N Roll 18132 44mm (1 3/4") of sizes Nurse:

Bag length 30cm (12") New Image Hollister Coupling/Flange SOS-0024 2 Piece Hollister Drainable Pouch Red N Transparent Lock N Roll 18133 57mm (2 1/4") No filter

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 34 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Maximum One Piece Urostomy System: Includes the cut-to-fit ostomy skin barrier and urostomy pouch as a single unit to collect urine with an integrated drain valve at the bottom to empty the bag. 1 Piece Urostomy Pouch Convex Light 10-23mm Coloplast Stoma Size SOS-0041 SenSura Mio Y Cut-to-Fit 16835 10-23mm (3/8-7/8") Light Convexity 1 Piece Urostomy Pouch Convex Light 15-33mm Coloplast Stoma Size SOS-0042 SenSura Mio Y 5 / Week Bag length 26cm (10 1/4") Cut-to-Fit 16836 15-33mm (5/8-1 1/4") Transparent 1 Piece Urostomy Pouch Convex Light 10-43mm Coloplast Stoma Size Maximum 10 SOS-0043 SenSura Mio Y Cut-to-Fit 16837 10-43mm (3/8-1 3/4") per patient 1 Piece Urostomy Pouch Convex Deep 10-23mm Coloplast Stoma Size admission SOS-0044 SenSura Mio Y Cut-to-Fit 16865 10-23mm (3/8-7/8") of any Deep Convexity 1 Piece Urostomy Pouch Convex Deep 15-33mm Coloplast Stoma Size combination SOS-0045 SenSura Mio Y Bag length 26cm (10 1/4") Cut-to-Fit 16866 15-33mm (5/8-1 1/4") of sizes Transparent 1 Piece Urostomy Pouch Convex Deep 10-43mm Coloplast Stoma Size SOS-0046 SenSura Mio Y Cut-to-Fit 16867 10-43mm (3/8-1 3/4") One Piece System with Drainable Pouches: A drainable pouch with a larger opening for ileostomies and colostomies. An integrated roll closure or clamp is used to keep the pouch closed until it requires emptying. Coloplast Stoma Size SOS-0047 1 Piece Drainable Pouch Flat 10-55mm Cut-to-Fit SenSura Mio Y 10481 10-55mm (3/8-1 1/8") 1 Piece Drainable Pouch Convex Light 10-23mm Coloplast Stoma Size SOS-0048 SenSura Mio Y Cut-to-Fit 16737 10-23mm (3/8-7/8") 1 Piece Drainable Pouch Convex Light 15-33mm Coloplast Stoma Size SOS-0049 SenSura Mio Y Cut-to-Fit 16738 15-33mm (5/8-1 1/4") 5 / Week Bag length 28cm (11") 1 Piece Drainable Pouch Convex Light 10-43mm Coloplast Stoma Size Easiclose™ SOS-0050 SenSura Mio Y Maximum 10 Cut-to-Fit 16739 10-43mm (3/8-1 3/4") Wide Outlet per patient 1 Piece Drainable Pouch Convex Deep 10-23mm Coloplast Stoma Size Transparent or Opaque (with inspection window) SOS-0051 SenSura Mio Y admission Cut-to-Fit 16755 10-23mm (3/8-7/8") of any 1 Piece Drainable Pouch Convex Deep 15-33mm Coloplast Stoma Size SOS-0052 SenSura Mio Y combination Cut-to-Fit 16756 15-33mm (5/8-1 1/4") of sizes 1 Piece Drainable Pouch Convex Deep 10-43mm Coloplast Stoma Size SOS-0053 SenSura Mio Y Cut-to-Fit 16767 10-43mm (3/8- 1 3/4") 1 Piece Drainable Pouch Flat 13-100mm Cut-to- Assura Coloplast Stoma Size SOS-0071 Fit Y Pouch size 13'' / 830 mL; Transparent Post-Op 12802 13-100mm (1/2- 3 7/8'')

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 35 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Maximum

Pediatric 2 Piece System: Two-piece system with adhesive coupling. Soft and comfortable - as soft and flexible as a one-piece pouch, ensuring freedom of movement while still wearing a two-piece.For newborns to children up to five years of age. The pediatric system is simple and easy to use and the coupling flange can be lifted so that the pouch can be applied without pressure on the peristomal area.

Colplast SOS-0069 2 Piece Pediatric Barrier Orange Flat Cut-to-Fit Easiflex Y Stoma Size 0-25mm (0 - 1") 14308 5 / Week

Maximum 10 Coupling/Flange per patient 27 mm (1") admission of any 2 Piece Pediatric Drainable Pouch Coloplast SOS-0070 Easiflex Y combination Transparent 14682 of sizes Bag 150 mL

Ostomy Accessories: Coloplast Each SOS-0054 Ostomy Support Belt for SenSura Mio Standard Brava Belt Y Standard Size 0423 up to 100 cm (40") 1 per Patient Coloplast Each Admission SOS-0055 Ostomy Support Belt for SenSura Mio XXL Brava Belt Y XXL Size 0424 up to 135 cm (61") Coloplast Each 5 / Patient Moldable. Fills gaps to create a tight seal to prevent SOS-0056 Ostomy Strip Paste Brava Y 2655 57g (2 oz) Admission leakage.

Each Coloplast Absorbs moisture and protects peristomal skin when SOS-0057 Ostomy Protective Sheet Brava 10 x10 cm Y 3 3210 used under the barrier to minimize risk of maceration 4 x 4"

Alcohol-free paste fills folds and creases to maintain Coloplast Each Tube 1 / Patient SOS-0058 Ostomy Paste (Tube) Brava Y a tight fit between the stoma and the ostomy barrier 12050 60g (2 oz) Admission to reduce leakage It absorbs moisture so the skin is kept dry to reduce Coloplast Each Bottle 1 / Patient SOS-0059 Ostomy Powder Brava Y irritation. Can be used around the stoma or under the 1907 25g (1 oz) Admission barrier baseplate.

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 36 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Maximum

A durable ring for reduced leakage. Creates a Coloplast 18 mm diameter durable seal between the stoma and the base plate, SOS-0066 Mouldable Skin Barrier Ring Brava Y 1 12045 4.2 mm thick thus reducing leakage. It is easy to use and can be molded to fit the patient's body shape.

Y 1 Maximum Quantity: 1 Kit/Patient Admission SOS-0065 Ostomy Care Kit Coloplast Coloplast Each Kit

One piece ostomy flat system 1

One piece ostomy convx light system 1

Scissors 1

Mirror 1

Adhesive Remover Wipe 1

Lubricating Deordorant 1

Measuring Guide & Marker 1

Coloplast Care Information and Forms (Billingual) 1

The following items require approval from LHIN Enterostomal Therapy Nurse:

Flexible pouches designed for skin protection and For wounds up to contain drainage from wounds, fistulas and difficult ConvaTec SOS-0060 Fistula and Wound Pouch Eakin 245 x 160 mm N 5 stoma sites. Horizontal cutting area. Suitable with 839264 (9.7" x 6.3") remote drainage attachment, tap closure & window for wound access.

Eakin ConvaTec Each SOS-0061 Skin Barrier Ring Small N Cohesive 839002 50 mm (2") Can be moulded to a variety of shapes to help 1 prevent leakage around the stoma by acting as filler Eakin ConvaTec Each SOS-0062 Skin Barrier Ring Large N for uneven skin surfaces. Cohesive 839001 100 mm (4")

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 37 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Maximum

Antimicrobial wound dressing that can be used under Hydrofera Hollister 60 mm (2.5") SOS-0063 Antimicrobial Ostomy Ring N 3 barriers. Manages bioburden to restore bacterial Blue HBRF2650 Diameter balance.

Infused with ceramide to help protect the peristomal Adapt Hollister 48 mm (2") SOS-0064 Ceramide Skin Barrier Ring N 1 skin's natural moisture barrier to prevent leakage and CeraRing 8805 Diameter dryness.

Ideal for wounds that are difficult to dress; Manages bacterial burden; Powder can convert any other Arglaes Medline Each 1 / Patient dressing to an antimicrobial; Contraindications: third- SOS-0067 Antimicrobial Sliver Alginate Powder N Powder MSC9205 5 gram Bottle Admission degree burns, patients with a known sensitivity to silver and as a surgical implant; Do not use topical antibiotics in conjunction with this powder

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 38 of 54 North East LHIN Home & Community Care Regional Approved Medical Supplies List

FEEDING, SUCTION & TRACHEOSTOMY SUPPLIES

Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Maximum Initial supply authorization for four weeks only for short-term treatment and to allow Patient to coordinate insurance or ADP applications. Supplies will only continue to be provided as per approved policy. LHIN- funded feeding supplies are available only for the LHIN funded Kangaroo ePump or Joey Pump and may not be compatible with other pumps. The LHIN is not obligated to provide supplies beyond defined periods while patients wait for third-party funding.

ENTERAL FEEDING Feeding Pumps - portable; adult & paediatric, ETM-1002 with auto flush functionality NOTE: Equipment is available for rental as per LHIN-approved policies from Medigas (Praixair). Please review to the Medigas Medical Equipment Catalogs for more detailed information before ordering. ETM-1005 IV pole - portable Covidien SFS-0005 Enteral Feeding Gravity Bag Kangaroo 1000 ml Y 2 To be used in the absence of a feeding pump. Non-sterile 8884702500 Kangaroo Covidien SFS-0006 Enteral Feeding Pump Set 500 ml 500 ml Y 2 Joey 762055 Kangaroo Covidien SFS-0031 Enteral Feeding Pump Set 1000 ml 1000 ml Y 2 Joey 763656 Enteral Feeding Pump Set with Flush Set Kangaroo Covidien SFS-0035 1000 ml Y 2 For continuous overnight feeds ONLY 1000ml Joey 763662 Kangaroo Covidien By request from Physician or Registed Dietician only for patients with a SFS-0045 Feeding Tubing Set with Safety Screw Spike 1 Tube Y 7 Joey 765559 clinical need for a closed system. Tubing only - no bag. Covidien 16 Fr x 9" 1/Patient SFS-0010 Gastrostomy Tube with Y Port 16 Fr Kangaroo Y 8884720163 20 cc Admission Covidien 20 Fr x 9" 1/Patient SFS-0036 Gastrostomy Tube with Y Port 20 Fr Kangaroo Y 8884720205 20 cc Admission Covidien 5 Fr x 20" Remains in situ for 30 days SFS-0012 Nasogastric Feeding Tube 5 Fr (Infant) Kangaroo Y 1/month 461412 1.7 mm x 51 cm Purple Polyurethane Sterile Covidien 5 Fr x 16" Used only for patients who pull them out frequently SFS-0037 Nasogastric Feeding Tube PVC 5 Fr (Infant) Kangaroo Y 2/week 460802 1.7 mm x 41 cm PVC Sterile Covidien 6.5 Fr x 36" Remains in situ for 30 days SFS-0038 Nasogastric Feeding Tube 6.5 Fr (Infant) Kangaroo Y 1/month 461438 2.2 mm x 91 cm Purple Polyurethane Sterile Kangaroo Covidien 12 Fr x 43" SFS-0015 Nasogastric Feeding Tube 12 Fr Y 1/month With stylet and rigid outlet port Entriflex 8884721252 4 mm x 109 cm

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 39 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Maximum Covidien Fits 16 Fr or 1/Patient SFS-0040 Adapter Y-Port-G-tube/P.E.G. 16 Fr Kangaroo Y Non-Sterile. For use with the Kangaroo P.E.G. Kits and can be used 8884751622 smaller Admission as the replacement Y-port on all Kangaroo gastrostomy tubes. 1 per Covidien Fits all 18 Fr or 1/Patient patient admission. LHIN will replace only if port is clogged or broken SFS-0041 Adapter Y-Port-G-tube/P.E.G. 20 Fr Kangaroo Y 8884752042 bigger Admission when patient still eligible for LHIN supplies. Covidien SFS-0044 Feeding Tube Y-Site Extension Set Kangaroo 12 inch Y 1 Not compatible with low-profile tubes like MIC-KEY or Nutriport 8884705008 Primarily used with pediatric patients. SECUR-LOK Right-Angle MIC-KEY Kimberly Clark SFS-0046 Low Profile Tube Feed Extension Set 12 inch Y 1 Connector; 2 Port "Y" connector and Tubing clamp for use with low- Secur-Lok 0121-12 profile MIC-KEY tubes. Not compatible with Nutriport low-profile tubes. Covidien SFS-0042 Purple Oral Syringe 3 ml Monoject 3 ml Y 3 Non sterile; reusable, can be washed 403S Covidien SFS-0043 Purple Oral Syringe 10 ml Monoject 10 ml Y 3 Non sterile; reusable, can be washed 410S Bard Order for babies and small children SFS-0039 Nasogastric Tube Stabilization Device (Pediatric) Statlok Pediatric Y 1 NG0100 For nasogastric tubes and feeding tubes Bard SFS-0019 Nasogastric Tube Stabilization Device (Adult) Statlok Adult Y 1 For nasogastric tubes and feeding tubes NG0120 SUCTION CATHETERS, TUBING AND ACCESSORIES Suction machine (includes nebulizer bottle, 2 ETM-1006 trach masks, and tubing) NOTE: Equipment is available for rental as per LHIN-approved policies from Medigas (Praixair). Please review to the Medigas Medical Equipment Catalogs for more detailed information before ordering. ETM-1015 Gastric Drainage Aspirator Allied SOT-0090 Disposable Suction Tubing Kit for ETM-1015 Gomco 18" and 72" Y 7 Includes two different length tubes per kit 01-90-2000 Allied SOT-0091 Disposable Filter (Box of 3) for ETM-1015 Gomco Box of 3 Y 1 Filter only needs replacing if it gets wet 01-90-3100 Allied SOT-0092 Disposable Collection Bottle for ETM-1015 Gomco 1100 mL Y 7 Plastic single use 01-90-3695 5–in-1 straight plastic connector to connect tubing to ETM-1015 SOT-0101 Connector for Suction Tubing for ETM-1015 Medline DYND50510 Each Y 7 Gastric Drainage Aspirator

Straight connectors feature ribbing which provides a firm connection to Medline SOT-0072 Universal Suction Tubing with Connectors Ornex 1/4" X 72" Y 1 suction devices of all kinds. OR66A Designed to handle 28 Hg pressure.

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 40 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Maximum

SOT-0053 Suction Catheter 8 FR Med-Rx CHS C13 8 Fr x 15" Y 7

Angled tip; Open; With control valve; Without tubing; Straight, Non- SOT-0054 Suction Catheter 12Fr Med-Rx CHS 50-1012 12 Fr x 21" Y 7 latex; Sterile

SOT-0055 Suction Catheter 14Fr Med-Rx CHS 50-1014 14 Fr x 21" Y 7

SOT-0057 Yankauer Suction Bulb Tip Medline DYND50130 Each Y 1

TRACHEOSTOMY PRODUCTS

NOTE: Additional products are available in the TRACHEOTOMY / DRAIN SPONGES category in the Dressings, Bandages, Tape, Compression & Wraps section Includes Disposable Tray, 4x4 Gauze, Plastic transfer Forcep, Pipe SOT-0032 Tracheostomy Care Kit Med-Rx 85-4037 Each Y 7 Cleaners, Cotton Tipped Applicators, Trach Sponges, Trach Brush, Twill Tape SOT-0033 Tracheostomy Brush Med-Rx 85-4206 Each Y 1

Covidien SOT-0034 Tracheostomy Ties One Size Shiley Each Y 1 Fits both adults and pediatric patients with neck size up to 18" TTH Covidien SOT-0077 Inner Cannula Disposable Size 4 Shiley Each Y 21 For use with Tracheostomy Tubes 4DCT, 4DFEN, 4DCFS, 4DCFN 4DIC Covidien For use with Tracheostomy Tubes 6DCT, 6DFEN, 6PERC, 6DCFS, SOT-0078 Inner Cannula Disposable Size 6 Shiley Each Y 21 6DIC 6DCFN Covidien For use with Tracheostomy Tubes 8DCT, 8DFEN, 8PERC, 8DCFS, SOT-0079 Inner Cannula Disposable Size 8 Shiley Each Y 21 8DIC 8DCFN Covidien SOT-0080 Fenestrated Inner Cannula Disposable Size 4 Shiley Each Y 21 For use with Tracheostomy Tubes 4DFEN, 4DCFN 4DICFEN Covidien SOT-0081 Fenestrated Inner Cannula Disposable Size 6 Shiley Each Y 21 For use with Tracheostomy Tubes 6DFEN, 6DCFN 6DICFEN Covidien SOT-0082 Fenestrated Inner Cannula Disposable Size 8 Shiley Each Y 21 For use with Tracheostomy Tubes 8DFEN, 8DCFN 8DICFEN

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 41 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Maximum OXYGEN MONITORING NOTE: Equipment is available for rental as per LHIN-approved policies from Medigas (Praixair). EPY-1008 Oximetry Monitor Please refer to the Medigas Medical Equipment Catalogs for more detailed information before ordering. Masimo Masimo SOT-0099 Infant Toe Sensor for EPY-1008 O2 Monitor Each Y 1 Single Patient Use. Includes one adhesive tape Canada 2328 Masimo Masimo SOT-0100 Replacement Tapes for Infant Toe Sensor Each Y 5 Single Patient Use, Replacement adhesive tape for SOT-0099 Canada 2307

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 42 of 54 North East LHIN Home & Community Care Regional Approved Medical Supplies List

I.V. SUPPLIES

Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Maximum NEEDLES & SYRINGES BD SIV-0079 Syringe Luer Lok 1mL Luer-Lok 1 mL Y 7 Luer Lok tip - Graduation 1/100 mL 309628 BD SIV-0080 Syringe Luer Lok 3 mL Luer-Lok 3 mL Y 7 Luer Lok tip - 0.2 mL graduations 309657 BD SIV-0081 Syringe Luer Lok 5 mL Luer-Lok 5 mL Y 7 Luer Lok tip - Graduation 1/5 mL 309646 BD SIV-0082 Syringe Luer Lock 10 mL Luer-Lok 10 mL Y 7 Luer Lok tip - Graduation 1/5 mL 302995 Luer Lok tip - Graduation: 1 mL For IV: 7 / Patient / Week BD See Notes SIV-0084 Syringe Luer Lok 30 mL Luer-Lok 30 mL Y For Wound Care: 1 / Patient / Week In-Home or 1 / Visit in Clinic 302832 --> Also order Wound Irrigation Tip for syringe for each dressing change (SDR-0062) BD SIV-0085 Syringe Luer Lok 60 mL Luer-Lok 60 mL Y 7 Luer Lok tip - Graduation: 1 mL , 2 oz in 1/4 oz 309653 BD 18g 1.5" SIV-0117 Blunt Fill Needle 18g 1.5" BD Y 3 305180 1.2 x 40 mm BD SIV-0173 Needle with Syringe 3 mL 23g 1" Eclipse 3mL 23g 1" Y 7 Eclipse Needle with Luer-Lok 305782 BD SIV-0175 Needle with Syringe 1mL 25g 5/8" Eclipse 1mL 25g 5/8" Y 7 Eclipse Needle with Luer-Lok 305780 BD SIV-0177 Needle with Syringe 1mL 27g 0.5" Eclipse 1mL 27g 0.5" Y 7 Eclipse Needle with Luer-Lok 305789 BD SIV-0181 Needle with Syringe 3mL 25g 5/8" Eclipse 3mL 25g 5/8" Y 7 Eclipse Needle with Luer-Lok 305781 Deltec Smiths Medical Non-coring needle without Y-site SIV-0192 Gripper Plus 22g x 3/4" Non Y-site 22 gauge x 3/4" Y 1 Gripper Plus 21-2766-24 Used to access implanted vascular access devices. Deltec Smiths Medical Non-coring needle without Y-site SIV-0193 Gripper Plus 19g x 1.25" Non Y-site 19 gauge x 1.25" Y 1 Gripper Plus 21-2765-24 Used to access implanted vascular access devices. BD 18g 1.5" 5 micron filter with blunt fill tip. Only to be used in Symptom Relief Kits SIV-0211 Blunt Fill Needle with Filter 18g x 1.5" BD Y 1/Kit 305211 1.2 x 40 mm for use when withdrawing fluid/medication from an ampoule

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 43 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Maximum PREFILLED SYRINGES: For flushing Vascular Access Devices as per nursing guidelines and manufacturer’s recommendations. Heparin Lock Syringe 10 USP units/mL - 5 mL BD 10 USP/mL SIV-0196 PosiFlush Y 3 Fill in 10 mL Diameter Syringe 306414 5 mL/mL Heparin Lock Syringe 10 USP units/mL - 3 mL BD 10 USP/mL SIV-0199 PosiFlush Y 3 Fill in 10 mL Diameter Syringe 306413 3 mL Heparin Lock Syringe 100 USP units/mL - 5 mL BD 100 USP/mL SIV-0197 PosiFlush Y 3 Fill in 10 mL Diameter Syringe 306424 5 mL Heparin Lock Syringe 100 USP units/mL - 3 mL BD 100 USP/mL SIV-0200 PosiFlush Y 3 Fill in 10 mL Diameter Syringe 306423 3 mL BD SSO-0021 Sodium Chloride 0.9% 10 mL Pre-Filled Syringe PosiFlush 10 mL Y 14 306575 I.V. SOLUTIONS Baxter SSO-0024 Sodium Chloride 0.9% INJ USP 100 mL Bag Viaflex 100 mL Y 7 JB1309M Baxter SSO-0025 Sodium Chloride 0.9% INJ USP 250 mL Bag Viaflex 250 mL Y 7 JB1322P Baxter SSO-0026 Sodium Chloride 0.9% INJ USP 500 mL Bag Viaflex 500 mL Y 7 JB1323 Baxter SSO-0027 Sodium Chloride 0.9% INJ USP 1000 mL Bag Viaflex 1000 mL Y 7 JB1324 Indicated only for diluting or dissolving medications for use in a SSO-0029 Sodium Chloride 0.9% 10 mL Vial Hospira 4888010 10 mL Y 7 nebulizer Indicated only for diluting or dissolving medications for use in a SSO-0032 Sterile Water 10 mL Vial Hospira 4887010 10 mL Y 7 nebulizer Dextrose 5% & Sodium Chloride 0.45% INJ USP Baxter SSO-0070 Viaflex 1000 mL Y 7 1000 mL Bag JB1074 Dextrose 3.3% & Sodium Chloride 0.3% INJ Baxter SSO-0034 Viaflex 1000 mL Y 7 USP 1000 mL Bag JB1034 Baxter SSO-0041 Dextrose 5% INJ USP 1000 mL Bag Viaflex 1000 mL Y 7 JB0064 Baxter SSO-0071 10% Dextrose INJ USP 1000 mL Bag Viaflex 1000 mL Y 7 JB0164 Baxter SSO-0046 Lactated Ringer's INJ USP 1000 mL Bag Viaflex 1000 mL Y 7 JB2324

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 44 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Maximum I.V. CATHETERS & ACCESS BD 22 gauge1.00" SIV-0150 IV Catheter 22g Blue Nexiva Y 3 Closed IV catheter system-Single port 383512 0.9 mm x 25 mm BD 24 gauge 0.75" SIV-0151 IV Catheter 24g Yellow Nexiva Y 3 Closed IV catheter system-Single port 383511 0.7 mm x 19 mm BD 18 gauge 1.25" Closed IV catheter system-Single port SIV-0228 IV Catheter 18g Green Nexiva N 2 383517 1.1 mm x 32 mm For MAiD Patients as approved by Care Coordinator BD 20 gauge 1.25" Closed IV catheter system-Single port SIV-0229 IV Catheter 20g Pink Nexiva N 4 383519 1.3 mm x 32 mm For MAiD Patients as approved by Care Coordinator BD 22 gauge 0.75" SIV-0187 IV Catheter Set - 22g Saf-T-Intima Y 3 Safety system with wings, extension tubing and Y adapter 383329 0.9 mm x 19 mm BD 24 gauge 0.75" SIV-0203 IV Catheter Set - 24g Saf-T-Intima Y 3 Safety system with wings, extension tubing and Y adapter 383319 0.9 mm x 19 mm I.V. GRAVITY SETS AND EXTENSION SETS Clearlink Baxter 10 drops / mL 2 Luer Activated Valves, Male Luer Lock Adapter, Approximate Volume SIV-0225 Continuous Flow IV Solution Set Y 7 Continu-Flo 2C8519 112" (2.8 m) 10 drops per mL Baxter 10 drops / mL SIV-0226 Secondary Medication Set Clearlink Y 7 With Male Luer lock adapter and hanger JC7453 37” (94 cm) Cardinal Health Length: 3 cm SIV-0009 Needle-Free Connector Valve MaxZero Y 7 Clear needleless connector MZ1000-07 Priming Volume Cardinal Health Length: 18 cm SIV-0012 Catheter Extension Set MaxZero Y 3 Extension set with clear needle-free connector valve MZ5301 Priming Volume Cardinal Health 7" / 8 cm Bifuse pressure rated extension set, 2 bonded MaxZero connectors, 2 SIV-0224 Y Connector IV Extension Set MaxZero Y 1 MZ5307 PV: 0.8 mL slide clamps, spin male luer lock I.V. DRESSINGS 3M 2.5 "x 2.75 " SDR-0094 Tegaderm IV Advanced Securement Dressing Tegaderm IV Y 3 For peripheral IVs 1683 6.5 cm x 7 cm

PICC/CVC Securement Device and Dressing Kit Tegaderm IV 3M 3 .5" x 4.5" • To secure Peripherally Inserted Central Catheters (PICC's) and short SIV-0231 (Regular) Advanced 1837-2100 8.5 cm x 11.5 cm term Central Venous Catheters (CVC's) • Designed to be worn for up to 7 days Y 1 • Removes cleanly, without causing patients undue pain or distress PICC/CVC Securement Device and Dressing Kit Tegaderm IV 3M 4" x 6" • Accommodates the majority of PICC and CVC catheters up to and SIV-0232 (Large) Advanced 1839-2100 10 cm x 15.5 cm including 12 French

NOTE: Additional items are also available in the TRACHEOTOMY / DRAIN SPONGES in the Dressings, Bandages, Tape, Compression & Wraps section

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 45 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Maximum INFUSION PUMP & SUPPLIES

ETM-1005 IV pole - portable A selection of IV equipment as per the LHIN Approved Regional Medical Equipment Catalog is available for rental as per policy from Ambulatory infusion pump with AC adaptor, 9V ETM-1009 the following approved providers: battery, small carry case - Robinson's Pharmasave Large carry case - for ambulatory infusion pump ETM-1012 - The Medicine Shoppe (if required) - Bayshore Specialty Rx Remote Dose Extension Cord for ETM-1009 IV ETM-1016 Pump Duracell Not used in Timmins or Kirkland Lake Branch service areas; Order as SOT-0038 9 Volt Batteries for Ambulatory Infusion Pump ProCell Each Y 1 PC1604BKD required for pumps elsewhere CME BBA120-161XPS Timmins and Kirkland Lake Branches Areas (Bayshore Rx) SIV-0042 Ambulatory Infusion Pump Administration Set Each Y 7 Smiths Medical CADD Sudbury, North Bay, Sault Ste. Marie, Parry Sound Branch Areas 21-7022-24 Ambulatory Infusion Pump High Volume Smiths Medical SIV-0043 CADD Each Y 7 Not used in Timmins or Kirkland Lake Branch service areas Administration Set 21-7055-24 CME CME Timmins and Kirkland Lake Branches Areas (Bayshore Rx) Ambulatory Infusion Pump Administration Set A120-112XSXFK SIV-0044 Each Y 7 Filtered Smiths Medical CADD Sudbury, North Bay, Sault Ste. Marie, Parry Sound Branch Areas 21-7036-01 ICU Medical ICU Timmins and Kirkland Lake Branches Areas (Bayshore Rx) Ambulatory Infusion Pump Extension Tubing 30 B1327 SIV-0045 30 inches Y 3 inches Smiths Medical CADD Sudbury, North Bay, Sault Ste. Marie, Parry Sound Branch Areas 21-7045-24 Ambulatory Infusion Pump Extension Tubing 45 Smiths Medical SIV-0046 CADD 45 inches Y 3 Sudbury, North Bay, Sault Ste. Marie, Parry Sound Branch Areas inches 21-7046-24 Ambulatory Infusion Pump Medication Cassette SIV-0047 50 mL Y 7 Sudbury, North Bay, Sault Ste. Marie, Parry Sound Branch Areas 50ml Ambulatory Infusion Pump Medication Cassette SIV-0048 100 mL Y 7 Sudbury, North Bay, Sault Ste. Marie, Parry Sound Branch Areas 100ml SIV-0202 IV Medication Refill Solution Bag Y 7 Solution bag - not a cassette. For IV Med Refill orders only

BLOOD COLLECTION SUPPLIES: For blood collection for patients eligible for in-home Lab Services as initiated by Care Coordinator only as per LHIN policy BD SIV-0137 Stretch Tourniquet Vacutainer 18" x 1" Y 1 367203 Blood collection infusion set with luer adapter BD 23 g x 0.75" 12" Tubing SIV-0145 Safety-Lok Y 3 23g 367283 Needle Manually activated safety shield to fully cover needle.

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 46 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Maximum Blood collection infusion set with luer adapter BD 21 g x 0.75" 12" Tubing SIV-0204 Safety-Lok Y 3 21g 367281 Needle Manually activated safety shield to fully cover needle Single patient use only - Discard the entire device. Needle is not part BD SIV-0212 Blood Tube holder Single Use Nonstackable Vacutainer Each Y 1 of the tube holder. One Blood Tube Holder can be used for all the 364815 blood work BD 13 x 75 mm x SIV-0205 Venous Blood Collection Tube - Lavender Vacutainer Y 3 367841 2.0 mL BD 13 x 100 mm x SIV-0206 Venous Blood Collection Tube - Yellow Vacutainer Y 3 367986 5.0 mL BD 13 x 75 mm x SIV-0207 Venous Blood Collection Tube - Blue Vacutainer Y 3 363083 2.7 mL BD 13 x 100 mm x SIV-0208 Venous Blood Collection Tube - Green Vacutainer Y 3 367962 4.5 mL BD 13 x 100 mm x SIV-0209 Venous Blood Collection Tube - Red Vacutainer Y 3 367815 6.0 mL Fisher Fisherbranded SIV-0210 Lab Specimen Bag 6" x 9" Y 1 With separate outside pocket holds the requisition slip Scientific 22310004 OTHER I.V. SUPPLIES & ACCESSORIES Busse or Cardinal Health SIV-0132 Sterile non-fenestrated drape 18x26" 18 x 26" Y 2 Multi-layered, absorbent, all-purpose sterile field equivalent 696 or equivalent Sterile bottle includes attached drain line with male luer connector and Vacuum Drainage Bottle 1000mL with 120cm MedQuest SIV-0213 PreVac 1000 mL Y 3 roller camp (drain at 12 PSI). Not to be used for body fluid samples for Tubing Set S55148 diagnostic testing Order SIV-0213 drainage bottle seperately. Includes dressings, tubing, Medquest MedQuest SIV-0214 Drainage Procedure Kit (Excludes Bottle) 1 Kit Y 3 alcohol wipes, vented luer cap, tube clamp, and chemo-rated Nitrile Medical 2976C gloves. Sterile. Medquest MedQuest Not required if ordering Kit 2976C (SIV-0214) for pts with luer lock SIV-0215 Sterile Vented Luer Cap Each Y 3 Medical 797A connections Includes 120 cm detachable drain line with rotating male luer fitting; Medquest MedQuest SIV-0216 Drainage Bag 4000 mL with 120cm Tubing Set 4000 mL Y 3 roller clamp; built in rotating hanger; integrated drip chamber and anti- Medical M08101 reflux valve Medquest MedQuest SIV-0217 Safety Drain Line Adapter Each Y 3 For use ONLY if patient has Pleurex catheter Medical SA5200 Medquest MedQuest SIV-0227 Universal Catheter Cap Each Y 3 For use ONLY if patient has Pleurex catheter Medical PCA-1050 Covidien 6.25x4.25x4.25" Accommodates a variety of Sharps; Temporary closure for security SIV-0131 Sharps Container Phlebotomy SharpSafety Y 1 8900SA 1 Litre between uses; Lids lock for safe transport and disposal.

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 47 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Maximum For the disposal of chemotherapy or other cytotoxic waste or for MAiD Covidien 10"x7.25"x10.5" SIV-0218 Sharps Container Chemotherapy ChemoSafety Y 1 patients as approved by the Care Coordinator. Temporary closure and 8982CRH 7.6 Litre locking lid for safe transport and disposal. Protects and cleans up spills of chemo or other hazardoudous Safetec SIV-0219 Spill Kit for Cytotoxic Drugs Safetec Each Y 1 medications. All inclusive kits contains all needed supplies and 48725 instructions. IV KITS: Prepared kits of commonly used items. Most items in each kit can be ordered individually if an entire kit is not required if an individual LHIN code is listed below. Additional items may also be ordered as needed. Y 1 Maximum Quantity: 1 Kit/Week SMK-0029 PICC Dressing Kit: All PICC/central lines require pump for infusion therapy. SDR-0005 Dressing Tray Kit 1 A large Ambulatory Infusion Pump carrying bag may be required, if SDR-0028 Tubular Net Elastic Bandage - Elbow & Arm 1 m necessary.

SIV-0231 PICC/CVC Securement Device and Dressing Kit (Regular) 1 Add: 2 of Ambulatory Infusion Pump Administration Sets (SIV-0042) OR Ambulatory Infusion Pump Administration Sets Filtered for SIV-0009 Needle-Free Connector Valve 1 administration of Cephalosporins, Vancomycin, Ceftazidine (SIV-0044) and 2 Alcohol Wipes (SS0-0052) AND 2 Sodium Chloride 0.9% SOT-0001 Disposable Ear Loop Surgical Face Mask 2 Syringes (SSO-0021) per day of infusion

SOT-0021 Sterile Nitrile Gloves Medium (Pair) 1 Add: Portacath Gripper item SIV-0192 or SIV-0193 as required.

SSO-0006 Chlorhexidine 2% Alcohol 70% Swabstick 2 Add: Prefilled Heparin Lock Syringes as per nursing guidelines (See IV, Needles, Syringes) SSO-0021 Sodium Chloride 0.9% 10 mL Pre-Filled Syringe 2 Dressing Tray SDR-0005 may be ordered individually if this entire For double lumen add the following to your order: PICC kit is not required. SIV-0009 Needle-Free Connector Valve 1 Y

SSO-0006 Chlorhexidine 2% Alcohol 70% Swabstick 1 Y

SSO-0021 Sodium Chloride 0.9% 10 mL Pre-Filled Syringe 2 Y

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 48 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Maximum SMK-0039 Subcutaneous Administration of Pain Management Medications via Infusion Pump: Initial Start Up Y 1 Maximum Quantity: 1 Kit/Week Kit 3 Extension tubing (SIV-0045 or SIV-0046) if being used with SWC-0072 Transparent Film Dressing 10 x 12cm 2 Add: medication cassette. SDR-0086 White Surgical Tape 1" Single Use Roll 1

SIV-0203 IV Catheter Set - 24g 2

SIV-0009 Needle-Free Connector Valve 1

SSO-0006 Chlorhexidine 2% Alcohol 70% Swabstick 4

SSO-0021 Sodium Chloride 0.9% 10 mL Pre-Filled Syringe 1

SSO-0052 Alcohol 70% Wipe 4 Weekly LHIN Code Description Qty per Kit APO Notes Max Qty Y 2 Maximum Quantity: 2 Kits/Week SMK-0040 Peripheral IV Start Kit: For infusion via pump order: Ambulatory Infusion Pump Administration SDR-0003 Gauze Sterile Woven 2"x2" (2 per Pack) 2 Set (SIV-0042) SDR-0028 Tubular Net Elastic Bandage - Elbow & Arm 1 m OR Ambulatory Infusion Pump Administration Set Filtered for SDR-0086 White Surgical Tape 1" Single Use Roll 1 administration of Cephalosporins, Vancomycin, Ceftazidine (SIV-0044) AND SIV-0009 Needle-Free Connector Valve 1 2 Chlorhexidine 2% Alcohol 70% Wipes (SS0-0069) AND SIV-0137 Stretch Tourniquet 1 2 Sodium Chloride 0.9% Syringes (SSO-0021) per day of infusion

SIV-0150 IV Catheter 22g Blue 2

SSO-0006 Chlorhexidine 2% Alcohol 70% Swabstick 4

SSO-0052 Alcohol 70% Wipe 4

SDR-0094 Tegaderm IV Advanced Securement Dressing 2

SSO-0021 Sodium Chloride 0.9% 10 mL Pre-Filled Syringe 2

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 49 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Maximum SMK-0041: Gravity Peripheral IV Administration Kit Y 2 Maximum Quantity: 2 Kit/Week

SIV-0225 Continu-Flo solution set 3 Provides 3 days of infusion

SSO-0024 Sodium Chloride 0.9% INJ USP 100 mL Bag 3 For increased frequency of medication administration beyond once daily, order additional Alcohol wipes (SSO-0052) and Prefilled Sodium SIV-0151 IV Catheter 24g Yellow 2 Chloride 0.9% Syringes (SSO-0021) per day of infusion

SIV-0009 Needle-Free Connector Valve 1 If additional line required add SIV-0226 Secondary IV set to the order

SDR-0028 Tubular Net Elastic Bandage - Elbow & Arm 1 m

SDR-0094 Tegaderm IV Advanced Securement Dressing 1

SSO-0006 Chlorhexidine 2% Alcohol 70% Swabstick 4

SSO-0052 Alcohol 70% Wipe 6

SSO-0021 Sodium Chloride 0.9% 10 mL Pre-Filled Syringe 6

SYMPTOM RELIEF SUPPLY KITS: LHIN area-specific medical supplies kits for pain and symptom management for SRC 95 End-of-Life patients. Prepared kits of commonly used items. Items in each kit can be ordered individually if an entire kit is not required. Additional items may also be ordered as needed. Y 1 Medication order must be provided to the LHIN-approved pharmacy SIV-0223: Symptom Relief Supply Kit - North Bay with the supplies order. LHIN-approved vendor will deliver medication SDR-0086 White Surgical Tape 1" Single Use Roll 1 and supply kit to the patient's home or alternate treatement address specificed by the LHIN SDR-0064 Sponge Synthetic Sterile Non-Woven 2"x2" (2 per Pack) 2

SIV-0009 Needle-Free Connector Valve 2

SIV-0117 Blunt Fill Needle 18g 1.5" 5

SIV-0175 Needle with Syringe 1mL 25g 5/8" 10

SIV-0203 IV Catheter Set - 24g 2

SSO-0052 Alcohol 70% Wipe 20

SWC-0072 Transparent Film Dressing 10x12cm 2

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 50 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Maximum Y 1 Medication order must be provided to the pharmacy with the supplies SIV-0220: Symptom Relief Supply Kit - Sudbury order. Includes home delivery within Greater Sudbury only: LHIN- approved vendor will deliver medication and supply kit to the patient's SIV-0131 Sharps Container Phlebotomy 1 treatement address as specificed by the LHIN. SDR-0094 Tegaderm IV Advanced Securement Dressing 3

SIV-0203 IV Catheter Set - 24g 3

SIV-0009 Needle-Free Connector Valve 3

SIV-0175 Needle with Syringe 1mL 25g 5/8" 20

SSO-0052 Alcohol 70% Wipe 20 Weekly LHIN Code Description Qty per Kit APO Maximum Notes Qty Y 1 Medication order must be provided to the LHIN-approved pharmacy SIV-0221: Symptom Relief Supply Kit - Timmins and the LHIN internal Medical Supplies prepares this kit SSO-0052 Alcohol 70% Wipe 25

SSO-0006 Chlorhexidine 2% Alcohol 70% Swabstick 4

SIV-0079 Syringe Luer Lok 1mL 25

SIV-0080 Syringe Luer Lok 3 mL 15

SIV-0117 Blunt Fill Needle 18g 1.5" 40

SIV-0203 IV Catheter Set - 24g 4

SWC-0072 Transparent Film Dressing 10x12cm 4

SIV-0131 Sharps Container Phlebotomy 1

SIV-0009 Needle-Free Connector Valve 4

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 51 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Maximum Y 1 Medication order must be provided to the LHIN-approved pharmacy SIV-0230: Symptom Relief Supply Kit - Kirkland Lake and the LHIN internal Medical Supplies prepares this kit. SSO-0052 Alcohol 70% Wipe 10

SUR-0091 Sterile Bacteriostatic Lubricant Water Based 2

SIV-0117 Blunt Fill Needle 18g 1.5" 3

SIV-0009 Needle-Free Connector Valve 3

SDR-0064 Sponge Synthetic Sterile Non-Woven 2"x2" (2 per Pack) 2

SSO-0006 Chlorhexidine 2% Alcohol 70% Swabstick 3

SIV-0079 Syringe Luer Lok 1mL 20

SIV-0175 Needle with Syringe 1mL 25g 5/8" 10

SIV-0203 IV Catheter Set - 24g 3

SWC-0072 Transparent Film Dressing 10x12cm 3

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 52 of 54 Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Maximum N 1 Pre-assembled kit of supplies required for use by the physican with MAIDKIT: MAiD Supplies Kit eligible, active patients approved for MAiD as per approved LHIN Home & Community Care policy. SDR-0003 Gauze Sterile Woven 2"x2" (2 per Pack) 4 When placing an order from Robinson's or LHIN Internal Medical SDR-0004 Gauze Sterile Woven 4"x4" (2 per Pack) 4 Supplies, add the delivery code #FC-1033 for LHIN-funded Home to this order. This Finance Charge is in addition to SDR-0028 Tubular Net Elastic Bandage - Elbow & Arm 1 Delivery for MAiD the appropriate Urban or Rural Delivery Finance Charge and only SDR-0086 White Surgical Tape 1" Single Use Roll 1 applicable to this kit.

SDR-0094 Tegaderm IV Advanced Securement Dressing 2

SIV-0009 Needle-Free Connector Valve 2

SIV-0012 Catheter Extension Set 18 cm 2

SIV-0218 Sharps Container Chemotherapy 1

SIV-0137 Stretch Tourniquet 1

SIV-0224 Y Connector IV Extension Set 2

SIV-0228 IV Catheter 18g Green 2

SIV-0229 IV Catheter 20g Pink 4

SOT-0096 Non Sterile Nitrile Gloves Large (Pair) 4

SSO-0006 Chlorhexidine 2% Alcohol 70% Swabstick 8

SSO-0021 Sodium Chloride 0.9% 10 mL Pre-Filled Syringe 6

SSO-0052 Alcohol 70% Wipe 8

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 53 of 54 North East LHIN Home & Community Care Regional Approved Medical Supplies List

PROTECTIVE WEAR

Manufacturer Weekly LHIN Code Description Brand Name Size APO Notes Code Maximum PROTECTIVE WEAR: Personal protective equipment (PPE) is authorized for LHIN staff to protect employees from exposure to workplace hazards as per LHIN policy. Service Providers are expected to provide their own personal protective equipment to their own staff to protect from infectious diseases, but LHIN will provide PPE to Service Providers handling hazarous chemicals/drugs for approved LHIN patients. Non-Sterile PPE may be authorized for contracted service providers by the LHIN only when the on-going patient-specific treatment requires protective wear be worn to minimize risk to patient as approved by the Care Coordinator. Clean PPE is standard in community care, and sterile PPE supplies are only to be authorized when treatments require a sterile technique as per approved policies or clinical guidelines. Medline Single use disposable; For use for protection from SOT-0004 Disposable Isolation Gown Regular/Large Medline Each N 1 per Visit CRI4000 chemotherapy or other cytotoxic medications in liquid Medline form (Intravenous, subcutaneous, intramuscular, liquid SOT-0098 Disposable Chemo Gown Regular/Large Medline Each N 1 per Visit NON27457 oral, etc.). NOTE: This face mask is not appropriate if Primaguard priMED Medical the cytotoxic medication is aerosolized - Use a fit-tested SOT-0001 Disposable Ear Loop Surgical Face Mask Each N 1 per Visit 120 PG4-1092 N95 mask provided by the nurse's employer. For procedures and patient-care activities likely to SOT-0019 Eye Protection Safety Glasses with Side Shields Medical Mart 485-W1080 Each N 1 generate splashes or sprays of blood or body fluids or cytotoxic medications in liquid form Cardinal Health Non-latex, powder free, nitrile examination gloves with SOT-0020 Sterile Nitrile Gloves Small (Pair) Flexam Each Pair Y 3 N8830 11 in. cuff. Approved for use with cytotoxic Cardinal Health medications. SOT-0021 Sterile Nitrile Gloves Medium (Pair) Flexam Each Pair Y 3 N8831 Nursing providers are requried to provide their staff with Cardinal Health non-sterile gloves. LHIN-funded sterile gloves are only SOT-0022 Sterile Nitrile Gloves Large (Pair) Flexam Each Pair Y 3 N8832 to be provided to nursing provider personnel when a Cardinal Health sterile technique is required for patient care as SOT-0023 Sterile Nitrile Gloves Extra Large (Pair) Flexam Each Pair Y 3 N8833 approved by the Care Coordinator Non-latex, powder free, nitrile examination gloves Cardinal Health Box of 40 SOT-0012 Sterile Nitrile Gloves Medium (Box) Flexam N 1 Bulk orders available Clinics and Residental Hospice N8831 Pairs only. Approved for use with cytotoxic medications. Cardinal Health SOT-0093 Non-Sterile Nitrile Gloves Small (Pair) Esteem XP Each Pair N 7 Non-latex, powder free, nitrile examination gloves. N8851XP ASTM F 739 Chemicals tested, but not for use with Cardinal Health SOT-0094 Non-Sterile Nitrile Gloves Medium (Pair) Esteem XP Each Pair N 7 chemotherapy. N8852XP Nursing providers are requried to provide their staff with Cardinal Health SOT-0096 Non-Sterile Nitrile Gloves Large (Pair) Esteem XP Each Pair N 7 non-sterile gloves. N8853XP Cardinal Health Bulk orders only available for LHIN staff ETs, NPs, SOT-0095 Non-Sterile Nitrile Gloves Medium (Box) Esteem XP Box of 50 N 1 N8852XP RRNs or aproved Clinics and Hospice

NE LHIN Approved Home & Community Care Regional Medical Supplies List_December 06 2017 Page 54 of 54

SUDBURY OFFICE BUREAU DE SUDBURY 40 Elm Street, Suite 41-C 40, rue Elm, bureau 41-C Sudbury ON P3C 1S8 Sudbury ON P3C 1S8 Tel : 705 522-3461 Téléphone : 705 522-3461 Toll Free : 1 800 461-2919 Sans frais : 1 800 461-2919 Fax : 705 522-3855 Télécopieur : 705 522-3855 TTY: 711 (ask operator 1-888-533-2222) ATS : 711 (veuillez demander au téléphoniste le 1-888-533-2222) www.nelhin.on.ca www.nelhin.on.ca