HOME AND COMMUNITY CARE SUPPORT SERVICES North East

Regional Medical Supplies List Revised May 1, 2021 Table of Contents Dressings, Bandages, Tape, Compression & Wraps 1 Gauze, Sponges & Packing 1 Tapes & Securement 2 Bandages & Wraps 3 Compression Wraps 4 Other, Specialty & Kits 5 Wound Care 6 Absorptives 6 Gelling Fiber & Antimicrobials Silver Gelling Fiber 6 Alginate & Antimicrobial Silver Alginate Dressings 7 Antimicrobial & Silver Dressings 7 Composite & Multifunction Dressings 9 Clear Acrylic Dressings 10 Foams 10 Hydrocolloids 11 Hydrogel 11 Films & Membranes 11 Odour Absorbent Dressings 12 Non-adherent 12 Offloading Devices 13 Other, Specialty & Kits 14 Negative Pressure Wound Therapy (NPWT) 18 Disposable Single-use NPWT 18 Reusable Foam NPWT 19 Cleansers & Antiseptic Solutions 22 Infusion I.V. Supplies 24 Needles & Syringes 24 Prefilled Syringes 24 I.V. Solutions 24 I.V. Catheters and Access 25 I.V. Gravity Sets & Extension Sets 26 I.V. Securement 26 Infusion Pump & Supplies 28 Blood Collection Supplies 29 Other IV Supplies & Accessories 30 I.V. Kits 31 Ostomy Supplies and Accessories 39 Ostomy Skin Barriers for 2 Piece System 39 Urostomy Pouches for 2 Piece System 40 Drainable Pouches for 2 Piece System 40 One Piece Urostomy System 41 One Piece System with Drainable Pouches 41 Pediatric 2 Piece System 42 Ostomy Accessories 42 Urinary Supplies 45 Foley Catheters 45 Intermittent Catheters 46 Urinary Drainage Bags 46 Catheter Stabilization 47 Catheter Accessories 47 Continuous Bladder Irrigation 47 Urinary Kits 48 Feeding, Suction & Tracheostomy Supplies 50 Enteral Feeding 50 Suction Catheters, Tubing and Accessories 51 Tracheostomy Products 52 Oxygen Monitoring 53 Protective Wear 54 Appendix A - Depot/Drop-off Locations A Algoma A-1 Nipissing - Temiskaming A-2 Cochrane A-4 Sudbury-Manitoulin-Parry Sound A-5

• The Regional Medical Supplies List identifies the items funded by Home and Community Care Support Services North East that are available to eligible patients who are authorized for Home and Community Care nursing services as per applicable policies. • If a different products are requested, an automatic substitution policy may be initiated to provide the equivalent product as identified within this list. • The Home and Community Care Support Services North East is not obligated to fund or provide any items that are not identified on this list. • Home and Community Care Support Services North East-funded nurses are expected to be trained on the supplies identified on this list, and use the supplies in alignment with the manufacturers’ recommendations. ______

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Please report any errors or feedback to [email protected] DRESSINGS, BANDAGES, TAPE, COMPRESSION & WRAPS CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code 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- Derma Sciences 2.25" x 3 yards SDR-0020 Sterile Small Woven Gauze 2" Roll Gazetex Y 7 ply. These bandages are used for wrapping or packing large and deep 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 SDR-0021 Sterile Large Woven Gauze 4" Roll Gazetex Y 7 dressing, the dressing provides additional cushioning and comfort. 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 Derma Sciences 1/4" x 5 yards SDR-0017 Sterile Packing Plain 1/4" (Bottle) PAK-ITS Y 2 Single-ply ribbon gauze strips that can be used dry to absorb drainage DUP59120 0.64cm x 4.5m 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

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 1 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Max 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 Derma Sciences 2" x 2" 14 SDR-0064 DuSoft Y Synthetic, 4 Ply, Pack of 2 per Pack) DUP84122 5 x 5 cm Packs of 2 Sponge Synthetic Sterile Non-Woven 4"x4" (2 Derma Sciences 4" x 4" 14 SDR-0065 DuSoft Y Synthetic, 4 Ply, Pack of 2 per 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, 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 Drain Sponge Antimicrobial Sterile Non-woven Covidien 4" x 4" 14 SOT-0024 Excilon Y PHMB, 6 Ply Non-woven, Pack of 2 4x4 Z7088 10 x 10cm 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 Derma Sciences SDR-0048 Montgomery Straps and Ties Montgomery 18 cm x 28 cm Y 1 Non-sterile, non-woven DUP97991

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 2 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Max 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" SDR-0027 NONNET02 Y 2 x 1 metre Fingers/Toes/Small Wrist Net 19.5 cm Medline Elastic 9 1/3" SDR-0083 Tubular Net Elastic Bandage - Wrist & Elbow NONNET03 Y 2 x 1 metre Net 23.7 cm Medline Elastic 11 2/3" SDR-0028 Tubular Net Elastic Bandage - Elbow & Arm NONNET04 Y 2 x 1 metre Net 29.6 cm Non-adhesive and holds dressing/devices securely in place while Medline Elastic 12 3/8" SDR-0029 Tubular Net Elastic Bandage - Knee & Thigh NONNET05 Y 2 x 1 metre allowing freedom of movement. Net 31.4 cm Roll of 25 yards cut to 1 meter lengths Tubular Net Elastic Bandage - Shoulder Hip Medline Elastic 17" SDR-0084 NONNET06 Y 2 x 1 metre Thigh Net 61 cm Tubular Net Elastic Bandage - Chest Back Medline Elastic 28 2/3" SDR-0030 NONNET07 Y 2 x 1 metre Perineum Axilla Net 72.8 cm Tubular Net Elastic Bandage - Chest Region Medline Elastic 31 1/3" SDR-0085 NONNET08 Y 2 x 1 metre Large Net 79.6 cm Medline Elastic 35" SDR-0031 Tubular Net Elastic Bandage - Chest Region XL NONNET09 Y 2 x 1 metre Net 88.9 cm Non-adhesive and holds dressing/devices securely in place while allowing freedom of movement. SPECIAL ORDER ITEM - May take up Tubular Net Elastic Bandage - Chest Region Medline Elastic 41" SDR-0035 NONNET10 Y 2 x 1 metre to 5 days for stock. XXL Net 93.1 cm

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 3 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Max Cardinal Health SCM-0003 Mesh Pants XL / XXL Wings 40"-56" Y 1 Z707A Incontinence supplies are not funded as per policy. These mesh pants Cardinal Health SCM-0004 Mesh Pants Large / XL Wings 32"-42" Y 1 are only authorized only for patients requiring this product as a means Z706A of containing wound care dressings to coccyx, perineal area, etc. Cardinal Health SCM-0005 Mesh Pants Small / Medium Wings 22"-32" Y 1 Z705A Cardinal Health SDR-0068 Multipurpose Tubular Elastic Bandage Size C Reliamed 2.75" x 36" Y 2 - Limb sizes C through G available. Other sizes may available only as ZG275TB an exception item special order with approval. Sizes intended as a Cardinal Health SDR-0069 Multipurpose Tubular Elastic Bandage Size D Reliamed 3" x 36" Y 2 guideline only and should be used in conjunction with existing clinical ZG30TB protocols that consider physiological state and wound and skin Cardinal Health SDR-0070 Multipurpose Tubular Elastic Bandage Size E Reliamed 3.5" x 36" Y 2 condition. ZG35TB - Order in 1 yard lengths (36") Cardinal Health 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 Health SDR-0072 Multipurpose Tubular Elastic Bandage Size G Reliamed 4.5" x 36" Y 2 - Contains latex 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.

SVS-0009 Tubular Elastic Compression Small Navy Stripe EdemaWear CA600001 Each Pair (2) Y 1/Month Up to 2 Pair at admission then 1 Pair per month as needed 15-20 mmHg; Air-permeable; Can be cut Tubular Elastic Compression Medium Yellow SVS-0010 EdemaWear CA960001 Each (1) Y 1/Month Small (Navy): Up to 18″/45cm circumference (Foot/Calf/Arm) Stripe Medium (Yellow): Up to 30″/75cm circumference (Knee/Thigh/Arm) Large (Red): Up to 46″/115cm circumference (Thigh/Torso) SVS-0011 Tubular Elastic Compression Large Red Stripe EdemaWear B120L01 Each (1) Y 1/Month

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 4 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Max OTHER & SPECIALTY: Incontinance supplies are not funded as per apprved policy. This Cardinal Cardinal product is authorized only for patients for containment of drainage or SCM-0019 Blue Absorbent Pad 23"x24" 23" x 24" Y 1/Visit Health UPSMD2324 for methotrexate administration in-home/clinic ONLY. Approved clinics may order in bulk. DRESSING KITS: CHS Y 1 For catheter treatments only (PNT or PICC). Not for use in wound SDR-0005 Dressing Tray Kit - Disposable Single Use MED-Rx Each Kit 85-4009 care. 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

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 5 of 54 WOUND CARE CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Max Home and Communuty Care Support Services North East-funded professional nurses are required to be trained on all wound care supplies that are funded. Nurses are expected to use the products in alignment with defined Wound Pathways and the manufacturer's product recommendations for use, contraindications, wear time, etc. 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 condition Mextra Super- Mölnlycke 8" x 12" SWC-0144 Super-Absorbent Dressing 8"x12" Y 4 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 Aquacel Ag ConvaTec 8" x 12" SWC-0153 Gelling Fiber Antimicrobial Silver Dressing 8"x12" Y 4 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

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 6 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code 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.

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 7 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Max Cardinal Health 4" x 4" SWC-0010 PHMB Antimicrobial Gauze Square 4"x4" Curity Y 7 Impregnated with 0.2% PHMB; 12 Ply Z2533 10.2 x 10.2 cm Cardinal Health 4" x 4" SWC-0112 PHMB Antimicrobial Non-Woven Sponges 4"x4" Kendall Z8044AMD or Y 7 Impregnated with 0.2% PHMB 10.1 x 10.1 cm equivalent Active ingredient is the cationic biocide, Derma Sciences 4" x 4" SWC-0169 Antimicrobial Woven Gauze 4"x4" (Pack of 2) Bioguard Y 4 polyDADMAC for protection against several DUP97412 10.1 x 10.1 cm pathogens including MSRA; 12 Ply - 2 Pack Cardinal Health 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 Z3332 11.4cm x 3.7m Active ingredient is the cationic biocide, Derma Sciences 4.5" x 4 1/8 yd SWC-0168 Antimicrobial Gauze Roll 4.5" Bioguard Y 7 polyDADMAC for protection against several DUP97322 11.4cm x 3.7m pathogens including MSRA. 6 Ply Cardinal Health 1/4" x 36" SWC-0115 Antimicrobial Gauze PHMB Ribbon 1/4" x 1 yard Curity Y 7 Impregnated with 0.2% PHMB Z7831AMD 0.6 x 91.4 cm Cardinal Health 1/2" x 36" SWC-0116 Antimicrobial Gauze PHMB Ribbon 1/2" x 1 yard Curity Y 7 Impregnated with 0.2% PHMB Z7832AMD 1.3 x 91.4 cm Cardinal Health 1" x 36" SWC-0117 Antimicrobial Gauze PHMB Ribbon 1" x 1 yard Curity Y 7 Impregnated with 0.2% PHMB Z7833AMD 2.5 x 91.4 cm Antimicrobial Gentian Violet Methylene Blue Hydrofera 4" x 4" SWC-0118 Hydrofera Blue Y 3 Dressing 4x4" HB4414 10 x 10 cm Antimicrobial Gentian Violet Methylene Blue Hydrofera 6" x 6" - Not to be used longer than 6 months without SWC-0137 Hydrofera Blue Y 3 Dressing 6x6" HB6614 15 x 15 cm consuting Wound Specialty Nurse. Antimicrobial Gentian Violet Methylene Blue Hydrofera Blue Hydrofera 4" x 5" SWC-0155 Y 1 - Not to be use on pregnant or nursing patients. Moist Foam Dressing 4x5" Ready HBRS4520 10 x 12.5cm Antimicrobial Gentian Violet Methylene Blue Hydrofera 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

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 8 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code 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.

- 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 wounds 4.25" x 4.25" SWC-0148 Non-Adhesive Pad Dressing (MAX) PolyMem MAX 5045 N 2 with heavier drainage or when longer wear time is 10.8 x 10.8 cm desired. SWC-0090 Protease Inhibitor Dressing with Collagen Promogran KCI 28 cm2 Y 2 Review manufacturer's information regarding M772028 Hexagonal contraindications. Protease inhibitor should be discontinued if there is SWC-0158 Protease Inhibitor Dressing with Silver Promogran KCI 2 Y 2 28 cm no progression towards wound healing (less than Prisma PS2028 Hexagonal 10% healing in 3 weeks). 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.

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 9 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Max 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

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

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 10 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Max 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

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 SWC-0159 Transparent Film Dressing 10cm x 1m Tegaderm 10 cm x 1 m Y Roll cut in 1 meter lengths per patient order 16004 Meter

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 11 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Max

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

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 12 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Max

OFFLOADING DEVICES: Offloading devices are used in the treatment of diabetic foot ulcers and include Total Contact Casts (TCC), custom braces and ankle and/or foot orthoses. These products can be ordered by any authorized prescriber (Nurse Practicioner, NSWOC, Physican or Chiropodist (internal or external))

Shoe Size (S) DJO Canada SWC-0165 Diabetic Walker Boot System - Small AirCast XP Male 4-7 Y 1 01PD-S - The XP Diabetic Walker Boot System incorporates Female 5-8 an optimized rocker sole, semi-rigid shells, an Shoe Size (M): DJO Canada innovative dual density insole and four aircells for SWC-0164 Diabetic Walker Boot System - Medium AirCast XP Male 7-10 Y 1 01PD-M maximum off -loading and “total contact” fit of the Female 8-11 diabetic foot. Two extra insoles (including the dual- Shoe Size (L): DJO Canada laminate Impax™ Grid insole), three stockings and SWC-0163 Diabetic Walker Boot System - Large AirCast XP Male 10-13 Y 1 01PD-L one hand bulb with pressure gauge are included. Female 11-15 - XL available only by special order and may take 3-5 Shoe Size (XL) DJO Canada days for stock SWC-0016 Diabetic Walker Boot System - X Large AirCast XP Male 13+ Y 1 01PD-XL Female 15+ DJO Canada SWC-0017 Diabetic Walker Insole Replacement Small AirCast XP Small Y 1 01PI-S The initial order of the Diabetic Walker Boot System includes two extra insoles. DJO Canada SWC-0027 Diabetic Walker Insole Replacement Medium AirCast XP Medium Y 1 01PI-M For use with the AirCast XP Diabetic Walker Boot DJO Canada SWC-0041 Diabetic Walker Insole Replacement Large AirCast XP Large Y 1 01PI-L XL size available only by special order and may take DJO Canada Extra SWC-0049 Diabetic Walker Insole Replacement X-Large AirCast XP Y 1 3-5 days for stock 01PI-XL Large Replacement hand bulb with pressure gauge. Replacement Inflation Device for Diabetic Walker DJO Canada A single hand bulb with pressure gauge is SWC-0162 AirCast XP Each Y 1 Boot 01PG already included with each order of a Diabetic Walker Boot System. Kit includes: Stockinette x1, Adehesive Felt x1, Adhesive Foam BSN Medical SWC-0166 Total Contact Cast Kit Cutimed 1 Kit N 1 x1, Padding Roll x2, Soft Fiberglass Cast Tape Rolls 7349900 x2, Plaster of Paris Slab x1, Fiberglass Cast Tape Roll x3

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 13 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code 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

Sharp/Blunt. For single-use, sterile techniques only. Not to be reused. CHS SDR-0011 Sterile Single Use Scissors MED-Rx 4 1/2" Y 7 85-4202 Clinic may order 1 / Patient / Visit In-Home may order 1 / Treatment Visit Non-sterile, Single patient use. For non-invasive, non- critial use. May be re-used by the same patient after 1 per Fisher cleaning or low-level disinfection as per nursing SDR-0036 Non-Sterile Reusable Scissors ALMP12 4 1/2" Y Patient Scientific guidelines. Admit Not for use in nursing clinics - Use SDR-0011 Sterile Single Use Scissors instead

CHS Sterile Single Use only SDR-0012 Sterile Plastic Thumb Forceps MED-Rx Each Y 1 / Visit 85-4200 1 / Patient / 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

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 14 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Max

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

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.

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 15 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Max

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.

1 Pack of 2 SDR-0006 Cotton Tipped Applicator Plastic Sterile 2/pk Medline MDS202095 Y 7 6" Long

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 CHRIS order 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

CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code 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 ambulatory nusing clinics. Clinics are expected to SDR-0065 Sponge Synthetic Sterile Non-Woven 4"x4" (2 per Pack) 4 have on hand and replenish stock as needed. 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

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 16 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code 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

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 17 of 54 NEGATIVE PRESSURE WOUND THERAPY (NPWT) CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code 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 policy.

DISPOSABLE SINGLE-USE NPWT: Cardinal NPWT PRO is the primary disposable single-use NPWT device, and the NANOVA will only be orderable by community nurses if approved/ordered by authorized Nurses Specialized in Wound, Ostomy and Continence (NSWOC), Nurse Practicioner, or Physician.

Cardinal NPWT PRO Unit, Dressings and Accessories Cardinal Health One unit provided every 42 days for a maximum of 2 per SNP-0070 NPWT PRO Unit NWPT PRO Each Y 1 6708888 patient admission. Power supply included Cardinal Health SNP-0072 NPWT PRO 300mL Canister with Gel NWPT PRO 300 mL Y 1 The default primary canister to be used 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 NPWT PRO Black Foam Dressing Kit - Cardinal Health q72 hours. Includes 1 Small Foam Dressing; 1 Drape; 1 SNP-0075 NWPT PRO 10x8x3 cm Y 3 Small 47-1702 Transfer pad with tubing NPWT PRO Black Foam Dressing Kit - Cardinal Health q72 hours. Includes 1 Medium Foam Dressing; 2 SNP-0076 NWPT PRO 20 x 12.5 x 3 cm Y 3 Medium 47-1701 Drapes; 1 Transfer pad with tubing NPWT PRO Black Foam Dressing Kit - Cardinal Health q72 hours. Includes 1 Large Foam Dressing; 2 Drapes; 1 SNP-0077 NWPT PRO 25 x 15 x 3 cm Y 3 Large 47-1700 Transfer pad with tubing NPWT PRO Black Foam Dressing Kit - Cardinal Health q72 hours. Includes 1 XL Foam Dressing; 2 Drapes; 1 SNP-0078 NWPT PRO 58.5 x 33 x 3 cm Y 3 XL 47-1703 Transfer pad 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 Regular drape in stock - Same as provided in NPWT SNP-0082 NPWT PRO Polyurethane Drape NPWT PRO 25.5 x 33 cm Y 2 47-7000 Dressing Kits For patients with very sensitive, fragile skin. NWPT PRO Cardinal Health 14" x 10" Hypoallergenic and can help prevent irritation or SNP-0074 NPWT PRO SensiSkin Drape Y 2 SensiSkin 47-7100 35 cm x 25 cm maceration. Special Order Only - May take up to 5 days for stock. Cardinal Health 1 per Only provided if patient loses original power supply SNP-0071 NPWT PRO AC Power Supply NWPT PRO Each Y 47-9100 Patient provided with unit (1 per patient admission if required)

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 18 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Max NANOVA Unit and Dressings Negative Pressure NANOVA NPWT Aceilty SNP-0062 NANOVA Each Unit Y 1/month One unit per month and 3 per patient admission max. Unit NANTU/R6.S NANOVA NPWT Dressing Kit Small Aceilty SNP-0063 NANOVA 18cm x 14cm Y 1 Dressings plus optional GRANUFOAM™ Wound Filler (Box of 3) NANGFS/R6.S NANOVA NPWT Dressing Kit Medium Aceilty SNP-0064 NANOVA 18cm x 18cm Y 1 Dressings plus optional GRANUFOAM™ Wound Filler (Box of 3) NANGFM/R6.S NANOVA NPWT Dressing Kit Large Aceilty SNP-0065 NANOVA 18cm x 28cm Y 1 Dressings plus optional GRANUFOAM™ Wound Filler (Box of 3) NANGFL/R6.S

REUSABLE FOAM NPWT: The ActiVAC NPWT system is the secondary treatment methodology for home and community care. ActiVAC is only to be used if the options for disposable single-use NPWT are not appropriate as authorized by the designated Nurses Specialized in Wound, Ostomy and Continence (NSWOC) in alignment with approved policy.

Reusable Foam NPWT LHIN-Owned KCI Continuous or Intermittent Modes, Intensity: Low, ETM-1014 ActiV.A.C. Each Y 12 Unit 340013 Medium, High Pressure Settings: -25 to -200 mmHg (-3.3 weeks to -26.6 kPa) Rental only allowed if owned unit is not max per KCI available. Rental unit will automatically be subsitiuted ETM-1010 Reusable Foam NPWT Rental Unit ActiV.A.C. Each Y patient 340013 with Owned unit when available as appropriate.

ActiVAC Dressing Kits: Includes the dressings, adhesive drapes and SensaTRAC Pad. Excess fluid and potentially infectious materials are removed from the wound through the Sensa TRAC pad and into the canister. VAC GranuFoam Standard Dressing Kit KCI Includes 1 small black foam dressing, 1 adhesive SNP-0008 V.A.C. 10x7.5x3.3 cm Y 3 Small M8275051 drape,1 SensaTRAC Pad VAC GranuFoam Standard Dressing Kit KCI Includes 1 medium black foam dressing, 2 adhesive SNP-0009 V.A.C. 18x12.5x 3.3 cm Y 3 Medium M8275052 drapes,1 SensaTRAC Pad VAC GranuFoam Standard Dressing Kit KCI Includes 1 large black foam dressing, 2 adhesive SNP-0010 V.A.C. 26x15x3.3 cm Y 3 Large M8275053 drapes,1 SensaTRAC Pad Includes 1 large black foam dressing, 5 adhesive VAC GranuFoam Standard Dressing Kit KCI SNP-0066 V.A.C. 60x30x1.5 cm Y 3 drapes,1 SensaTRAC Pad. SPECIAL ORDER ITEM - XL M8275065 May take up to 5 days for stock. VAC GranuFoam Silver Dressing Kit KCI Includes 1 small silver foam dressing, 1 adhesive SNP-0017 V.A.C. 10x7.5x3.3 cm Y 3 Small M8275098 drape,1 SensaTRAC Pad VAC Granufoam Silver Dressing Kit KCI Includes 1 medium silver foam dressing, 2 adhesive SNP-0018 V.A.C. 18x12.5x3.3 cm Y 3 Medium M8275096 drapes,1 SensaTRAC Pad VAC Granufoam Silver Dressing Kit KCI Includes 1 large silver foam dressing, 2 adhesive SNP-0019 V.A.C. 26x15x3.3 cm Y 3 Large M8275099 drapes,1 SensaTRAC Pad

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 19 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Max Less adherent material helps promote graft take. KCI SNP-0020 VAC WhiteFoam Dressing Kit Small V.A.C. 10x7.5x1 cm Y 3 Includes 1 small PVA foam dressing, 1 adhesive drape, M8275068 1 SensaT.R.A.C. Pad Less adherent material helps promote graft take. KCI SNP-0022 VAC WhiteFoam Dressing Kit Large V.A.C. 10x15x1 cm Y 3 Includes 1 large PVA foam dressing,1 adhesive drape, 1 M8275067 SensaT.R.A.C. Pad KCI Includes 1 small Spiral-cut VAC GranuFoam Dressing, 2 SNP-0046 VAC Simplace Dressing Kit Small V.A.C. Each Y 3 M8275046 adhesive drapes, 1 SensaT.R.A.C. Pad KCI Includes 1 medium Spiral-cut VAC GranuFoam SNP-0048 VAC Simplace Dressing Kit Medium V.A.C. Each Y 3 M8275045 Dressing, 2 adhesive drapes, 1 SensaT.R.A.C. Pad

ActiVAC Accessories: Additional dsposable components to optimise individual treatment to or when treating multiple wounds.

Included in the Standard Dressing Kits bellow. This KCI is an adhesive layer spread across the foam dressing, SNP-0001 VAC Adhesive Drape V.A.C. 30.5 x 26 cm Y 1 M6275009 ensuring a closed, moist wound healing environment.

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 1 polyvinyl alcohol (PVA) foam dressing (10 x 7.5 x 1 SNP-0058 VAC WhiteFoam Small (Foam Only) V.A.C. 10 x 7.5 x 1 cm Y 3 M6275033 cm) 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 1 canister with gel, tubing, clamp and connector; May be SNP-0052 300 mL ActiVAC Canister with Gel V.A.C. Each Y 1 M8275058 authorized for more than 1/week if the canister is full.

KCI Includes 1 SensaT.R.A.C. Pad with tubing, clamp and SNP-0060 VAC SensaT.R.A.C. Pad V.A.C. Each Y 1 M8275057 connector

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

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 20 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Max KCI SNP-0067 VAC GranuFoam Bridge Dressing Kit V.A.C. Each Y 3 Each kit includes black foam, bridge dressing; sensa M8275042 TRAC pad and adhesive drape. SPECIAL ORDER VAC GranuFoam Bridge XG Dressing KCI SNP-0068 V.A.C. Each Y 3 ITEM - May take up to 5 days for stock. Kit M8275044

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 21 of 54 CLEANSERS & ANTISEPTIC SOLUTIONS CHRIS Manufacturer Description Brand Name Size APO Weekly Max Notes Order Code 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 JF7633P When used for for wound care these items are approved only for: 1) Immunocomprimised patient (i.e. BMT, Oncology, Organ Derma Sciences SSO-0023 Normal Saline 118 mL Irrigation Bottle Sterile Derma 118 mL Y 7 Transplant 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 Small Antiseptic skin preparation swabsticks for maintenance of indwelling SSO-0006 Chlorhexidine 2% Alcohol 70% Swabstick SoluPrep Y 8 102.03 1.6 mL vascular access catheters. Single use Single use antiseptic topical skin cleanser prior to an injection SSO-0052 Alcohol 70% Wipe Y 28 Loris Medium-sized wipe 70% Isopropyl Alcohol; Single use Cardinal 30 x 65 mm LP103-03 3 Boxes per For Residential Hospice bulk orders only in Sault Ste. Marie and SSO-0072 Alcohol 70% Wipe - Box of 200 N Month Sudbury - 3 boxes maximum per month Loris SSO-0054 Povidone Iodine 10% Wipe Cardinal 30 x 65 mm Y 3 LP109-01 Single use 10% PVP-I antiseptic/germicide prep used for wound 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 Review manufacturer's product information regarding SSO-0004 Povidone Iodine 10% 115mL Bottle Loris 115 mL Y 2 LP109-09 contraindications.

SSO-0011 Hygeol 1:20 500 mL N/A N/A 500 mL Y 7 per 2 wks Maximum 14/patient

B. Braun 1 per For cleansing, moistening and decolonization of acute and chronic SSO-0073 Wound Irrigation Gel Antimicrobial 30 mL Bottle Prontosan 30 mL Y BB400510 28 days skin wounds, 1st and 2nd degree burns. (NERDS: Non-healing, Wound Irrigation Solution Antimicrobial 350 mL B, Braun 1 per Exudate, Red/bleeding, Debris, Smell). This product is not to be used SSO-0074 Prontosan 350 mL Y Bottle BB400431 28 days to replace potable water cleansing

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 22 of 54 CHRIS Manufacturer Description Brand Name Size APO Weekly Max Notes Order Code Code Miscellaneous

Oral Swab sticks Latex-free Plain Untreated Sage Products 2 Boxes per For Residential Hospice bulk orders only in Sault Ste. Marie and SOT-0083 Toothette Box of 250 N (Box 250) 5602UT Month Sudbury - 2 boxes maximum per month 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

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 23 of 54 I.V. SUPPLIES CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Maximum NEEDLES & SYRINGES

SIV-0079 Syringe Luer Lok 1mL Y 7 Luer Lok tip - Graduation 1/100 mL BD Luer-Lok 1 mL 309628 3 Boxes per For Residential Hospice bulk orders only in Sault Ste. Marie and SIV-0238 Syringe Luer Lok 1mL - Box of 100 N Month Sudbury - 3 boxes maximum per month

SIV-0080 Syringe Luer Lok 3 mL Y 7 Luer Lok tip - 0.2 mL graduations BD Luer-Lok 3 mL 309657 2 Boxes per For Residential Hospice bulk orders only in Sault Ste. Marie and SIV-0239 Syringe Luer Lok 3 mL - Box of 200 N Month Sudbury - 2 boxes maximum per month 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 : 1 / Patient / Week In-Home or 1 / Visit in Clinic 302832 --> For Wound Care Also order Wound Irrigation Tip for syringe for each dressing change (SDR-0062) BD SIV-0085 Syringe Luer Lok 50 mL Luer-Lok 50 mL Y 7 Luer Lok tip - Graduation: 1 mL , 2 oz in 1/4 oz 309653

SIV-0117 Blunt Fill Needle 18g 1.5" Y 3 BD 18g 1.5" BD 305180 1.2 x 40 mm 2 Boxes per For Residential Hospice bulk orders only in Sault Ste. Marie and SIV-0240 Blunt Fill Needle 18g 1.5" - Box of 100 N Month Sudbury - 2 boxes maximum per month 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

SIV-0177 Needle with Syringe 1mL 27g 0.5" Y 7 Eclipse Needle with Luer-Lok BD Eclipse 1mL 27g 0.5" 305789 3 Boxes per For Residential Hospice bulk orders only in Sault Ste. Marie and SIV-0241 Needle with Syringe 1mL 27g 0.5" - Box of 50 N Month Sudbury - 3 boxes maximum per month

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 24 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Maximum BD SIV-0181 Needle with Syringe 3mL 25g 5/8" Eclipse 3mL 25g 5/8" Y 7 Eclipse Needle with Luer-Lok 305781 Smiths Medical Non-coring needle without Y-site SIV-0192 Gripper Plus 22g x 3/4" Non Y-site Gripper Plus 22 gauge x 3/4" Y 1 21-2766-24 Used to access implanted vascular access devices. Smiths Medical Non-coring needle without Y-site SIV-0193 Gripper Plus 19g x 1.25" Non Y-site Gripper Plus 19 gauge x 1.25" Y 1 21-2765-24 Used to access implanted vascular access devices. 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" Y 1/Kit BD 18g 1.5" for use when withdrawing fluid/medication from an ampoule BD Blunt Fill Needle with Filter 18g x 1.5" - Box of 305211 1.2 x 40 mm 2 Boxes per For Residential Hospice bulk orders only in Sault Ste. Marie and SIV-0242 N 100 Month Sudbury - 2 boxes maximum per month PREFILLED SYRINGES: For the sole purpose of flushing Vascular Access Devices as per nursing guidelines and manufacturer’s recommendations. Home and Community Care Support Services North East shall not fund or provide any other concentrations of Heparin as medications for injections or other uses. 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

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 25 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Maximum Sodium Chloride 0.9% 10 mL Vial Preservative- Hospira Indicated only for diluting or dissolving medications for use in a SSO-0029 954354 10 mL Y 7 free or equivalent nebulizer Hospira or Indicated only for diluting or dissolving medications for use in a SSO-0032 Sterile Water 10 mL Vial 954469 10 mL Y 7 equivalent 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 USP Baxter SSO-0034 Viaflex 1000 mL Y 7 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

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 383519 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 383517 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

SIV-0203 IV Catheter Set - 24g Y 3 Safety system with wings, extension tubing and Y adapter BD 24 gauge 0.75" Saf-T-Intima 383319 0.9 mm x 19 mm 2 Boxes per For Residential Hospice bulk orders only in Sault Ste. Marie and SIV-0243 IV Catheter Set - 24g - Box of 25 N Month Sudbury - 2 boxes maximum per month

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 26 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Maximum 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) Length: 3 cm Cardinal Health SIV-0009 Needle-Free Connector Valve MaxZero Priming Volume Y 7 Clear needleless connector MZ1000-07 0.19 mL Length: 18 cm Cardinal Health SIV-0012 Catheter Extension Set MaxZero Priming Volume Y 3 Extension set with clear needle-free connector valve MZ5301 0.3 mL 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. SECUREMENT: Securement devices and dressings used to maintain catheter securement, and protect peripheral and central catheter insertion sites and wounds. The primary product is the Tegaderm IV Advanced and IV3000 is only to be authorized for patient-specfic cases if Tegaderm IV dressings are clinically not appropriate due to sensitivity.

SDR-0094 Tegaderm IV Advanced Securement Dressing Y 3 For peripheral IVs 3M 2.5 "x 2.75" Tegaderm IV Tegaderm IV Advanced Securement Dressing - 1683 6.5 cm x 7 cm 2 Boxes per For Residential Hospice bulk orders only in Sault Ste. Marie and SIV-0244 N Box of 100 Month Sudbury - 2 boxes maximum per month

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

Only to be ordered if Tegaderm IV dressings are not appropriate. IV 3000 Smith & Nephew 4" x 4-3/4" SIV-0236 IV3000 Securement Dressing Y 2 Dressing only for Central/PICC/midline catheters. 1Hand 4008 10cm x 12cm Secures catheter in place when using the IV3000 dressing when StatLock PICC Bard SIV-0134 StatLock IV Catheter Securement Device Each Y 1 required to secure PICC line. Accommodates a wide variety of PICC Plus PIC0220 Catheters. Tricot Anchor Pad, Sliding Post, Sterile. NOTE: Additional items are also available in the TRACHEOTOMY / DRAIN SPONGES in the Dressings, Bandages, Tape, Compression & Wraps section

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 27 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Maximum INFUSION PUMPS & SUPPLIES

ETM-1005 IV pole - portable A selection of IV equipment as per the Home and Community Care North East Approved Regional Medical Equipment Catalog is Ambulatory infusion pump with AC adaptor, 9V ETM-1009 available for rental as per policy from 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 7 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 21-7345-24 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 21-7346-24 ICU Medical ICU 20 inches Timmins and Kirkland Lake Branches Areas (Bayshore Rx) B1327 SIV-0045 Ambulatory Infusion Pump Extension Tubing Set Y 3 Smiths Medical CADD 30 Inches 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 Each Y 7 Solution bag - not a cassette. For IV Med Refill orders only

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 28 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Maximum SINGLE USE ELASTOMERIC DISPOSABLE PUMP & SUPPLIES: The primary IV pump is a re-usable ambulatory infusion pump. If a single-use pump is requested by the patient or physician, elastomeric/single-use pumps shall only be provided if medications are funded under the Ontario Drug Benefit (ODB). Other costs related to elastomeric pumps that are not covered by ODB are the sole responsiblity of the patient. See also Infusion Therapy Policies SPECIAL ORDER ITEM: Care Coordinator to confirm ODB Baxter or coverage and timing for availability with the approved IV SIV-0233 Elastomeric Single Use Disposable IV Pump Various Each N 1 equivalent pharmacy prior ordering pump. The pump type/size is selected by pharmacy per medication type. Baxter One-Link 7N8379K 17" (42.0 cm) 3 per SIV-0234 Elastomeric IV Pump Catheter Extension Set Y For use with SIV-0233 Elastomeric pump only. or equivalent 1.8 mL pump For use with select SIV-0233 Elastomeric pumps only. SIV-0235 Elastomeric IV Pump Belt Carrying Bag Baxter 2C1100 or equivalent Each N 1 / patient 1 bag per pump is permissible per patient admission. BLOOD COLLECTION SUPPLIES: For blood collection for patients eligible for in-home Lab Services as initiated by Care Coordinator only as per policy

BD SIV-0137 Stretch Tourniquet Vacutainer 18" x 1" Y 1 367203

BD 23 g x 0.75" 12" Tubing SIV-0145 Blood collection infusion set with luer adapter 23g Safety-Lok Y 3 367283 Needle Manually activated safety shield to fully cover needle.

BD 21 g x 0.75" 12" Tubing SIV-0204 Blood collection infusion set with luer adapter 21g Safety-Lok Y 3 367281 Needle Manually activated safety shield to fully cover needle Single patient use only - Discard the entire device. Needle is not part of BD SIV-0212 Blood Tube holder Single Use Nonstackable Vacutainer Each Y 1 the tube holder. One Blood Tube Holder can be used for all the blood 364815 work per patient

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

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 29 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Maximum 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 Transparent Blue, Non-Sterile Single Use Disposable SIV-0210 Lab Specimen Bag 6" x 10" Y 1 Scientific 22310004 With separate outside pocket holds the requisition slip

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 separately. 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-0245 Drainage Bag 2000mL with 120cm Tubing Set 2000 mL Y 7 roller clamp; built in rotating hanger; integrated drip chamber and anti- Medical M04200 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 Cardinal Health 6.25x4.25x4.25" Accommodates a variety of Sharps; Temporary closure for security SIV-0131 Sharps Container Phlebotomy SharpSafety Y 1 Z8900SA 1 Litre between uses; Lids lock for safe transport and disposal. For the disposal of chemotherapy or other cytotoxic waste or for MAiD Cardinal Health 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 14399 instructions.

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 30 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Maximum IV KITS: Prepared kits of commonly used items. Most items in each kit can be ordered individually if an entire kit is not required and the individual CHRIS order 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 necessary.

SDR-0028 Tubular Net Elastic Bandage - Elbow & Arm 1 m Add: 2 of Ambulatory Infusion Pump Administration Sets (SIV-0042) OR Ambulatory Infusion Pump Administration Sets Filtered for SIV-0231 PICC/CVC Securement Device and Dressing Kit (Regular) 1 administration of Cephalosporins, Vancomycin, Ceftazidine (SIV-0044) and 2 Alcohol Wipes (SS0-0052) AND 2 Sodium Chloride 0.9% SIV-0009 Needle-Free Connector Valve 1 Syringes (SSO-0021) per day of infusion

Add: Portacath Gripper item SIV-0192 or SIV-0193 as required. SOT-0001 Disposable Ear Loop Surgical Face Mask 2 Add: Prefilled Heparin Lock Syringes as per nursing guidelines (See IV, SOT-0021 Sterile Nitrile Gloves Medium (Pair) 1 Needles, Syringes)

SSO-0006 Chlorhexidine 2% Alcohol 70% Swabstick 2 Dressing Tray SDR-0005 may be ordered individually if this entire PICC kit is not required.

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

For double lumen add the following to your order:

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

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 31 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Maximum SMK-0039 Subcutaneous Administration of Pain Management Medications via Infusion Pump: Initial Start Up Y 1 Maximum Quantity: 1 Kit/Week Kit Add: Extension tubing (SIV-0045 or SIV-0046) as needed if being used SWC-0072 Transparent Film Dressing 10 x 12cm 2 with 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

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 32 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Maximum 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) OR Ambulatory Infusion Pump Administration Set Filtered for administration SDR-0028 Tubular Net Elastic Bandage - Elbow & Arm 1 m of Cephalosporins, Vancomycin, Ceftazidine (SIV-0044) AND SDR-0086 White Surgical Tape 1" Single Use Roll 1 2 Chlorhexidine 2% Alcohol 70% Wipes (SS0-0069) AND SIV-0009 Needle-Free Connector Valve 1 2 Sodium Chloride 0.9% Syringes (SSO-0021) per day of infusion

SIV-0137 Stretch Tourniquet 1

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

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 33 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Maximum Y 2 Maximum Quantity: 2 Kit/Week SMK-0041: Gravity Peripheral IV Administration Kit Provides 3 days of infusion SIV-0137 Stretch Tourniquet 1 For increased frequency of medication administration beyond once daily, order additional Alcohol wipes (SSO-0052) and Prefilled Sodium SDR-0086 White Surgical Tape 1" Single Use Roll 1 Chloride 0.9% Syringes (SSO-0021) per day of infusion

SDR-0003 Gauze Sterile Woven 2"x2" (2 per Pack) 2 If additional line required add SIV-0226 Secondary IV set to the order

SIV-0225 Continu-Flo solution set 3 Additional catheters may be ordered as needed

SSO-0024 Sodium Chloride 0.9% INJ USP 100 mL Bag 3

SIV-0151 IV Catheter 24g Yellow 2

SIV-0009 Needle-Free Connector Valve 1

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

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 34 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Maximum SYMPTOM RELIEF SUPPLY KITS: Geographic 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 geographically designated SIV-0223: Symptom Relief Supply Kit - North Bay approved Infusion Supplies pharmacy provider with the supplies order. The approved Infusion Supplies provider will deliver medication and SDR-0086 White Surgical Tape 1" Single Use Roll 1 supply kit to the patient's home or alternate treatement address specified in the order 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 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: Designated approved Infusion Supplies pharmacy provider will deliver SIV-0131 Sharps Container Phlebotomy 1 medication and supply kit to the patient's treatement address as specified in the order. SDR-0086 White Surgical Tape 1" Single Use Roll 1

SDR-0094 Tegaderm IV Advanced Securement Dressing 4

SIV-0203 IV Catheter Set - 24g 4

SIV-0009 Needle-Free Connector Valve 3

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

SSO-0052 Alcohol 70% Wipe 20

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 35 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Maximum Y 1 Medication order must be provided to the Designated approved Infusion SIV-0221: Symptom Relief Supply Kit - Timmins Supplies pharmacy provider and the Home and Community Care North East Internal Medical Supplies prepares this supply 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 Y 1 Medication order must be provided to the Designated approved Infusion SIV-0230: Symptom Relief Supply Kit - Kirkland Lake Supplies pharmacy provider and the Home and Community Care North East Internal Medical Supplies prepares this supply kit SSO-0052 Alcohol 70% Wipe 10

SIV-0211 Blunt Fill Needle with Filter 18g x 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

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 36 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Maximum Y 1 The medication order may be provided by any local pharamcy, but the SIV-0237: Symptom Relief Supply Kit - Manitoulin supplies are provided by the designated approved Infusion Supplies pharmacy provider 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

SDR-0086 White Surgical Tape 1" Single Use Roll 1

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

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 37 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code 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 Home and Community Care Support Services North East policy. SDR-0003 Gauze Sterile Woven 2"x2" (2 per Pack) 4 When placing an order from Robinson's or Internal Medical Supplies, SDR-0004 Gauze Sterile Woven 4"x4" (2 per Pack) 4 add the delivery code #FC-1033 for LHIN-funded Home Delivery for MAiD to this order. This Finance Charge is in addition to the SDR-0028 Tubular Net Elastic Bandage - Elbow & Arm 1m appropriate Urban or Rural Delivery Finance Charge and only applicable to this kit. SDR-0086 White Surgical Tape 1" Single Use Roll 1

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

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 38 of 54 OSTOMY SUPPLIES & ACCESSORIES CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code 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 Home and Community Care Support Services North East-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 primary vendor and therefore Hollister and ConvaTec and other products require the approval of a designated Nurses Specialized in Wound, Ostomy and Continence (NSWOC) 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") 2 Piece Click Barrier Blue Convex Light Cut-to- SenSura Mio Coloplast Coupling/Flange SOS-0029 Y Light Convexity, Stoma size 15-40mm (5/8"- 1 9/16") Fit Click 16921 60 mm (2 3/8") 2 Piece Click Barrier Yellow Convex Light Cut-to- SenSura Mio Coloplast Coupling/Flange 5 / Week SOS-0030 Y Light Convexity, Stoma size 15-53mm (5/8"- 2 1/16") Fit Click 16931 70 mm (2 3/4") 2 Piece Click Barrier Green Convex Deep Cut-to- SenSura Mio Coloplast Coupling/Flange Maximum 10 SOS-0031 Y Deep Convexity, Stoma size 10-20mm (3/8"- 3/4") Fit Click 16941 40 mm (1 9/16") per patient 2 Piece Click Barrier Red Convex Deep Cut-to- SenSura Mio Coloplast Coupling/Flange admission SOS-0032 Y Deep Convexity, Stoma size 15-30mm (5/8"- 1 1/8") Fit Click 16951 50 mm (2") of any 2 Piece Click Barrier BlueConvex Deep Cut-to- SenSura Mio Coloplast Coupling/Flange combination Deep Convexity, Stoma size 15-40mm (5/8"- 1 SOS-0033 Y Fit Click 16961 60 mm (2 3/8") of sizes 9/16") 2 Piece Click Barrier Yellow Convex Deep Cut-to- SenSura Mio Coloplast Coupling/Flange Deep Convexity, Stoma size 15-53mm (5/8"- 2 SOS-0034 Y Fit Click 16971 70 mm (2 3/4") 1/16") The following items require approval from designated NSWOC 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

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 39 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code 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 a designated NSWOC Nurse: admission of any Hollister Coupling/Flange May only be ordered with the Hollister 2-Piece SOS-0021 2 Piece Hollister Urostomy Pouch Green Hollister Y combination 18902 44mm (1 3/4") Barrier as approved by NSWOC of sizes Bag length 23cm (9") Hollister Coupling/Flange Transparent SOS-0022 2 Piece Hollister Urostomy Pouch Red Hollister Y 18903 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 desingated NSWOC Nurse: admission of any New Image Hollister Coupling/Flange combination May only be ordered with the Hollister 2-Piece SOS-0023 2 Piece Hollister Drainable Pouch Green N Lock N Roll 18132 44mm (1 3/4") of sizes Barrier as approved by NSWOC

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

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 40 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code 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- Coloplast Stoma Size admission SOS-0044 SenSura Mio Y 23mm Cut-to-Fit 16865 10-23mm (3/8-7/8") of any Deep Convexity 1 Piece Urostomy Pouch Convex Deep 15- Coloplast Stoma Size combination SOS-0045 SenSura Mio Y Bag length 26cm (10 1/4") 33mm Cut-to-Fit 16866 15-33mm (5/8-1 1/4") of sizes Transparent 1 Piece Urostomy Pouch Convex Deep 10- Coloplast Stoma Size SOS-0046 SenSura Mio Y 43mm 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. 1 Piece Drainable Pouch Flat 10-55mm Cut-to- Coloplast Stoma Size SOS-0047 SenSura Mio Y Fit 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- Coloplast Stoma Size Transparent or Opaque (with inspection window) SOS-0051 SenSura Mio Y admission 23mm Cut-to-Fit 16755 10-23mm (3/8-7/8") of any 1 Piece Drainable Pouch Convex Deep 15- Coloplast Stoma Size SOS-0052 SenSura Mio Y combination 33mm Cut-to-Fit 16756 15-33mm (5/8-1 1/4") of sizes 1 Piece Drainable Pouch Convex Deep 10- Coloplast Stoma Size SOS-0053 SenSura Mio Y 43mm 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'')

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 41 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code 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 1907 25g (1 oz) Admission the barrier baseplate.

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 42 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code 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 a designated NSWOC 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")

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 43 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Maximum

Hydrofera Hydrofera 60 mm (2.5") - Not to be used longer than 6 months. SOS-0063 Antimicrobial Ostomy Ring N 3 Blue HBRF2650 Diameter - Not to be use on pregnant or nursing patients.

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 CeraRing 8805 Diameter and dryness.

Ideal for wounds that are difficult to dress; Manages bacterial burden; Powder can convert any other Medline Each 1 / Patient dressing to an antimicrobial; Contraindications: third- SOS-0067 Silver Ionic Powder AG+ N MSC9405 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

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 44 of 54 URINARY & DRAINAGE SUPPLIES CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code 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. Home and Community Care Support Servcies North East-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 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 365712 5 mL Balloon BARD 14 Fr SUR-0002 Foley 2 Way Hydrogel Coated Latex 14Fr 5 mL BARD Canada Y 2/month 365714 5 mL Balloon BARD 16 Fr SUR-0003 Foley 2 Way Hydrogel Coated Latex 16Fr 5mL BARD Canada Y 2/month 365716 5 mL Balloon BARD 18 Fr SUR-0004 Foley 2 Way Hydrogel Coated Latex 18Fr 5 mL BARD Canada Y 2/month 365718 5 mL Balloon BARD 14 Fr SUR-0014 Foley 2 Way Hydrogel Coated Latex 14Fr 30mL BARD Canada Y 2/month 366714 30 mL Balloon BARD 16 Fr SUR-0015 Foley 2 Way Hydrogel Coated Latex 16Fr 30 mL BARD Canada Y 2/month 366716 30 mL Balloon BARD 18 Fr SUR-0016 Foley 2 Way Hydrogel Coated Latex 18Fr 30 mL BARD Canada Y 2/month 366718 30 mL Balloon BARD 20 Fr SUR-0017 Foley 2 Way Hydrogel Coated Latex 20Fr 30 mL BARD Canada Y 2/month 366720 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 5 SUR-0117 Foley 2 Way Red Latex Tiemann Coude Tip 16Fr 5 mL BARD Canada Y 2/month enlarged prostate) 0102L16 mL Balloon Coloplast 12 Fr SUR-0027 Foley 2 Way 100% Silicone 12 Fr 10mL Folysil Y 2/month 100% Silicone; Sterile; Single-patient use; Non-latex AA6112 10 mL Balloon Coloplast 14 Fr SUR-0028 Foley 2 Way 100% Silicone 14Fr 10mL Folysil Y 2/month 100% Silicone; Sterile; Single-patient use; Non-latex AA6114 10 mL Balloon Coloplast 16 Fr SUR-0037 Foley 2 Way 100% Silicone 16Fr 15mL Folysil Y 2/month 100% Silicone; Sterile; Single-patient use; Non-latex AA6116 15 mL Balloon Coloplast 18 Fr SUR-0046 Foley 2 Way 100% Silicone 18Fr 15mL Folysil Y 2/month 100% Silicone; Sterile; Single-patient use; Non-latex AA6118 15 mL Balloon Coloplast 18 Fr SUR-0033 Foley 2 Way 100% Silicone 18Fr 30mL Folysil Y 2/month 100% Silicone; Sterile; Single-patient use; Non-latex AA6C18 30 mL Balloon

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 45 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Maximum Coloplast 20 Fr SUR-0034 Foley 2 Way 100% Silicone 20Fr 30mL Folysil Y 2/month 100% Silicone; Sterile; Single-patient use; Non-latex AA6C20 30 mL Balloon Coloplast 14 Fr SUR-0047 Foley 2 Way 100% Silicone Coude Tip 14Fr 15mL Folysil Y 2/month Tiemann (coude) tip for difficult insertions. Features a bent tip that AA6314 15 mL Balloon maneuvers around obstructions leading to the bladder (eg. men with Coloplast 16 Fr SUR-0121 Foley 2 Way 100% Silicone Coude Tip 16Fr 15mL Folysil Y 2/month enlarged prostate). Latex free AA6316 15 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 Coloplast SUR-0125 Male External Condom Catheter Silicone 23mm Freedom Clear 23 mm Y 7 Standard Adhesive; Non-sterile; Single Patient Use; Disposable 505711 Coloplast SUR-0126 Male External Condom Catheter Silicone 28mm Freedom Clear 28 mm Y 7 Standard Adhesive; Non-sterile; Single Patient Use; Disposable 505731 Coloplast SUR-0127 Male External Condom Catheter Silicone 31mm Freedom Clear 31 mm Y 7 Standard Adhesive; Non-sterile; Single Patient Use; Disposable 505741 URINARY DRAINAGE BAGS: Urine drainage bags are used to collect urine by attaching to a catheter. Single patient use leg bags are for use with Foley Catheters. 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 Flip-Flo Valve with Straps and 18" Dispoz-A-Bag 19oz / 562ml - For long-term catheter users, the bags should be replaced every 5-7 SUR-0085 Bard Canada Y 2 Tubing 150180 18" Tubing days - Bags must be emptied when 1/3 to 1/2 full Dispoz-A-Bag 19 oz / 562ml SUR-0086 Leg Bag 562 mL Flip-Flo Valve with Straps Bard Canada Y 2 - Adjustable straps are included and attached to the leg bags. 1501MF Each - No longer best practice to change bag for overnight use unless the Dispoz-A-Bag 32 oz / 946ml volume requires this to prevent leakage/overflow; SUR-0089 Leg Bag 946mL Flip Flo Valve with Straps Bard Canada Y 2 1501LF Each - Larger sized 2000 ml bag often used for patients who are bedridden or end of life. Drainage Bag 2000mL with Anti-Reflux Device, 2000 mL SUR-0090 Bard Canada Bard 153504C Y 2 - Single use only. Do not resterilize. Reuse may create a risk of Catheter tubing and Metal Drain Clamp Each patient or user infection 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 Nephrostomy Drainage Bag 600 mL Argon DBAG600 600 mL Y 1 Provide 2 at admission then 1 / week until discharge.

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 46 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Maximum 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 Star Plex Fisher Scientific Sterile polypropylene container for collection, transport and storage of SUR-0108 Specimen container 90 mL Y 2 Scientific 360993197 specimens, Single use, Disposable CONTINUOUS BLADDER IRRIGATION (CBI): Approved for time-limited treatment for Continuous Bladder Irrigation only. Usually required to discharge patient from hospital for end of life or hospice care. Treatment may be as frequent at 1 bag/hour per day. As ordered Must be authorized/ordered by Care Coordinator Baxter SUR-0122 0.9% Sodium Chloride Irrigation Solution 3000 mL Baxter 3000 mL N by SPECIAL ORDER ITEM: Availability of stock with the vendor needs to JB7127I Physician be confirmed prior to ordering. 0.195” Inner Dia. Includes tubing, drip chamber, regulating clamp, and catheter adapter. Baxter SUR-0123 Bladder Irrigation Tubing Set Baxter Length: 2.1m Y 1 Plug directly into 3-way catheter or us catheter adaptor unit when 2- JC4040 (81″ Long) way catheter is used. Patient usually discharged from hospital with required catheter. Coloplast 22 Fr Couvalier tip appropriate for both male and female patients. SUR-0124 Foley 3 Way Catheter for CBI Silicone 22 Fr X-Flow Y 1 AB6122 30-50 mL Balloon Additional patient-specific sizes available with Exception Item Request approval

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 47 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code 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 CHRIS order 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

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 48 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Maximum NE LHIN Various - See each Y 1 Patient usually discharged from hospital with required catheter. SMK-0008 Percutaneous Nephrostomy Kit: Each Kit item Additional patient-specific sizes available as per this catalog or by Exception Item Request approval SDR-0005 Dressing Tray Kit - Disposable Single Use 2

SDR-0055 Drain Gauze Sponge Trach Sterile Woven 4"x4" 2

SOT-0001 Disposable Ear Loop Surgical Face Mask 2

SOT-0021 Sterile Nitrile Gloves Medium (Pair) 2

SSO-0021 Normal Saline 10 mL Pre-Filled Syringe 1

SSO-0052 Alcohol 70% Wipe 14 Leg Bag Kit 600 mL Flip-Flo Valve with Straps and 18" SUR-0085 1 Tubing SWC-0128 Transparent Film Dressing 15x20cm 2

SUR-0103 Drainage Tube Universal 1 Way Stopcock 2 Y 1 To be ordered by and provided to Nurse Practitioners or Physicians SMK-0044 Paracentesis Drainage Kit only for abdomen or chest drainage procedures for eligible palliative Not CardioMed patients to support end of life care. Paracentesis Drainage Tray w/9cm Catheter Smartap 1 Applicable CM-0020T Home and Community Care Support Services North East will provide the medical supplies to the physician for eligible patients only. SDR-0086 White Surgical Tape 1" Single Use Roll 1 Funding or supplies for topical or local anesthetic for drainage procedures is not available and is to be provided by the physician or is SOT-0001 Disposable Ear Loop Surgical Face Mask 2 at the cost of the patient.

SCM-0019 Blue Absorbent Pad 23"x24" 2

SSO-0006 Chlorhexidine 2% Alcohol 70% Swabstick 2

SOT-0021 Sterile Nitrile Gloves Medium (Pair) 2

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 49 of 54 FEEDING, SUCTION & TRACHEOSTOMY SUPPLIES CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Maximum

Initial supply authorization for four weeks only for short-term treatment and to allow patients to coordinate insurance or ADP applications. Supplies will only continue to be provided as per approved policy. Funded feeding supplies shall only be provided for Kangaroo ePump or Joey Pump and may not be compatible with other pumps. Home and Community Care Support Services North East 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 approved policies from Medigas (Praixair). Please review to the Medigas Medical Equipment Catalogs for more detailed information before ordering. ETM-1005 IV pole - portable

Cardinal Health SFS-0005 Enteral Feeding Gravity Bag Kangaroo 1000 ml Y 2 To be used in the absence of a feeding pump. Non-sterile Z8884702500 Kangaroo Cardinal Health SFS-0006 Enteral Feeding Pump Set 500 ml 500 ml Y 2 Joey Z762055 Kangaroo Cardinal Health SFS-0031 Enteral Feeding Pump Set 1000 ml 1000 ml Y 2 Joey Z763656 Kangaroo Cardinal Health SFS-0035 Enteral Feeding Pump Set with Flush Set 1000ml 1000 ml Y 2 For continuous overnight feeds ONLY Joey Z763662 Kangaroo Cardinal Health 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 Z765559 clinical need for a closed system. Tubing only - no bag. Cardinal Health 16 Fr x 9" 1/Patient SFS-0010 Gastrostomy Tube with Y Port 16 Fr Kangaroo Y Z8884720163 20 cc Admission Cardinal Health 20 Fr x 9" 1/Patient SFS-0036 Gastrostomy Tube with Y Port 20 Fr Kangaroo Y Z8884720205 20 cc Admission Cardinal Health 5 Fr x 20" Remains in situ for 30 days SFS-0012 Nasogastric Feeding Tube 5 Fr (Infant) Kangaroo Y 1/month Z461412 1.7 mm x 51 cm Purple Polyurethane Sterile Cardinal Health 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 Z460802 1.7 mm x 41 cm PVC Sterile Cardinal Health 6.5 Fr x 36" Remains in situ for 30 days SFS-0038 Nasogastric Feeding Tube 6.5 Fr (Infant) Kangaroo Y 1/month Z461438 2.2 mm x 91 cm Purple Polyurethane Sterile Kangaroo Cardinal Health 12 Fr x 43" SFS-0015 Nasogastric Feeding Tube 12 Fr Y 1/month With stylet and rigid outlet port Entriflex Z8884721252 4 mm x 109 cm

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 50 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Maximum Cardinal Health 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 as Z8884751622 smaller Admission the replacement Y-port on all Kangaroo gastrostomy tubes. 1 per Cardinal Health Fits all 18 Fr or 1/Patient patient admission. Replace only if port is clogged or broken when SFS-0041 Adapter Y-Port-G-tube/P.E.G. 20 Fr Kangaroo Y Z8884752042 bigger Admission patient still eligible for supplies. Cardinal Health SFS-0044 Feeding Tube Y-Site Extension Set Kangaroo 12 inch Y 1 Not compatible with low-profile tubes like MIC-KEY or Nutriport Z8884705008 Cardinal Health Non sterile; Can be reused if washed with same patient SFS-0042 Purple Enteral Oral Syringe 3 ml Monoject 3 ml Y 3 Z403S For Neonatal and Pediatric Feeding Systems Cardinal Health Non sterile; Can be reused if washed with same patient SFS-0043 Purple Enteral Oral Syringe 10 ml Monoject 10 ml Y 3 Z410S For Neonatal and Pediatric Feeding Systems Purple Enteral Oral Syringe 35 ml Sterile with Tip Cardinal Health For Neonatal and Pediatric Feeding Systems SFS-0047 Monoject 35 ml Y 3 Cap Z435SG Sterile, Single Patient Use with Nasogastric Feeding Tube 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. 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 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 Patient Use 01-90-3695 5–in-1 straight plastic connector to connect tubing to ETM-1015 Gastric SOT-0101 Connector for Suction Tubing for ETM-1015 Medline DYND50510 Each Y 7 Drainage Aspirator

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 51 of 54 CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Maximum 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.

SOT-0053 Suction Catheter 8 FR Med-Rx CHS 50-1008 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 Medtronic SOT-0034 Tracheostomy Ties One Size Shiley Each Y 1 Fits both adults and pediatric patients with neck size up to 18" TTH Trach Inner Cannula Disposable Beveled Tip for Medtronic I.D. x Length For use with Tracheostomy Tubes Green 4CN65H or 4UN65H SOT-0014 Shiley Y 21 6.5mm Tube Green 4IC65 5.5mm x 62mm BPA & DEHP Free; Non-Latex; Non-sterile; Single-patient use Trach Inner Cannula Disposable Beveled Tip for Medtronic I.D. x Length For use with Tracheostomy Tube Orange 5CN70H or 5UN70H SOT-0102 Shiley Y 21 7.0mm Tube Orange 5IC70 6.0mm x 68mm BPA & DEHP Free; Non-Latex; Non-sterile; Single-patient use Trach Inner Cannula Disposable Beveled Tip for Medtronic I.D. x Length For use with Tracheostomy Tube Light Blue 6CN75H or 6UN75H SOT-0015 Shiley Y 21 7.5mm Tube Light Blue 6IC75 6.5mm x 74mm BPA & DEHP Free; Non-Latex; Non-sterile; Single-patient use Trach Inner Cannula Disposable Beveled Tip for Medtronic I.D. x Length For use with Tracheostomy Tube Purple 7CN80H or 7UN80H SOT-0103 Shiley Y 21 8.0mm Tube Purple 7IC80 7.0mm x 77mm BPA & DEHP Free; Non-Latex; Non-sterile; Single-patient use Trach Inner Cannula Disposable Beveled Tip for Medtronic I.D. x Length For use with Tracheostomy Tube Navy 8CN85H or 8UN85H SOT-0018 Shiley Y 21 8.5mm Tube Navy Blue 8IC85 7.5mm x 79mm BPA & DEHP Free; Non-Latex; Non-sterile; Single-patient use Medtronic SOT-0080 Fenestrated Inner Cannula Disposable Size 4 Shiley 4.9mm x 62mm Y 21 For use with Tracheostomy Tubes 4DFEN, 4DCFN 4DICFEN Medtronic SOT-0081 Fenestrated Inner Cannula Disposable Size 6 Shiley 6.0mm x 62mm Y 21 For use with Tracheostomy Tubes 6DFEN, 6DCFN 6DICFEN Medtronic SOT-0082 Fenestrated Inner Cannula Disposable Size 8 Shiley 7.5mm x 79mm Y 21 For use with Tracheostomy Tubes 8DFEN, 8DCFN 8DICFEN

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OXYGEN MONITORING NOTE: Equipment is available for rental as per 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

Home and Community Care Support Services North East - Regional Approved Medical Supplies List_May 1, 2021 Version Page 53 of 54 PROTECTIVE WEAR CHRIS Manufacturer Weekly Description Brand Name Size APO Notes Order Code Code Maximum PROTECTIVE WEAR: Personal protective equipment (PPE) is authorized for Home and Community Care Support Services North East staff to protect employees from exposure to workplace hazards as per policy. Service Providers are expected to provide their own personal protective equipment to their own staff to protect from infectious diseases. Service Providers may be provided PPE if handling hazarous chemicals/drugs for approved patients. Non-Sterile PPE may be authorized for contracted Service Providers 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 320-NON24777V 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. Sterile gloves will only to be provided SOT-0022 Sterile Nitrile Gloves Large (Pair) Flexam Each Pair Y 3 N8832 to nursing service provider personnel when a sterile Cardinal Health technique is required for patient care as approved by SOT-0023 Sterile Nitrile Gloves Extra Large (Pair) Flexam Each Pair Y 3 N8833 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 required 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 Home and Community SOT-0095 Non-Sterile Nitrile Gloves Medium (Box) Esteem XP Box of 50 N 1 N8852XP Care North East clinical staff or Clinics or Hospices

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Regional Approved Medical Supplies List

Appendix A Depot/Drop-off Locations

Revised May 1, 2021 Home and Community Care Support Services North East – Regional Medical Supplies List Appendix A - DEPOT/DROP-OFF LOCATIONS

ALGOMA SUB-REGION (Questions or issues call: 705-949-1808 / 1-800-668-7705 Ext: 3269) Service Depot/Drop-Off Availability For Regular Scheduled Pick-Up Location Service Type Area Location Pick-up* URBAN Home and 750 Great Northern Rd. MON-FRI 8:30AM – 4:30PM Soo Medical (Robinson’s) Community Care Sault Ste. Marie, ON For Home and Community Care Medical Supplies Support Services 3rd Floor – Office #3095 Support Staff use only – Sault Ste. Marie Not for Patient Pick-up Office URBAN Soo Medical 656 Great Northern Road, MON-FRI 8:30AM - 4:30PM Soo Medical (Robinson’s) Sault Ste. Marie, ON P6B 4Z9 (IV) Equipment & Supplies, 705-574-0228 Medical Supplies Fax: 705-574-0231 URBAN The Medicine 316 Second Line West MON-FRI 9:00AM– 6:00PM Medicine Shoppe’s Infusion Shoppe Sault Ste. Marie, ON P6C 2J5 SAT 9:00AM–2:00PM (IV) Equipment & Supplies 705-253-0720/877-374-6938 Fax: 705-256-7656 URBAN ParaMed Clinic 477 Queen Street East MON-FRI 8:00AM– 8:00PM Soo Medical (Robinson’s) Suite 100 SAT-SUN 8:00AM– 8:00PM Medical Supplies Sault Ste. Marie, ON, P6A 1Z5 705-759-0110 For ParaMed Clinic Patients only URBAN Algoma 229 Fourth Line W Sault Ste., Orders arrive weekly on Tuesdays Soo Medical (Robinson’s) Residential Marie, ON P6A 0B5 and Fridays Medical Supplies & Hospice Care 705-942-1556 For Hospice Residents only Medicine Shoppe’s Infusion (ARCH) (IV) Equipment & Supplies RURAL Matthews Memorial 1180 Richards Street, Orders arrive weekly on Thursdays Soo Medical (Robinson’s) Hospital Richards Landing, ON P0R 1J0 Open 24 hrs Medical Supplies 705-246-2570 RURAL *Thessalon Hospital 135 Dawson Street Orders arrive weekly on Thursdays Soo Medical (Robinson’s) (Due to COVID – Thessalon, ON P0R 1L0 Open 24 hrs Medical Supplies HOME DELIVERY) 705-842-2014 RURAL Pit Stop Gas Bar & 3245 Hwy 17 East, Orders arrive weekly on Fridays Soo Medical (Robinson’s) Confectionary Echo Bay, ON P0S 1C0 MON-SAT 6:00AM –10:00PM Medical Supplies 705-248-3333 SUN 8:00AM – 10:00PM RURAL Goulais River 2771 Hwy 17 North Orders arrive weekly on Fridays Soo Medical (Robinson’s) Country Store Goulais River, ON P0S 1E0 MON-SUN 6:00AM -11:00PM Medical Supplies 705-649-3811 RURAL McCauley’s Village 5235 Hwy 17 North Orders arrive weekly on Fridays Soo Medical (Robinson’s) Store Haviland Bay, ON P0S 1E0 MON-SUN 8:30AM – 10:00PM Medical Supplies 705-649-5813 SUN 7:00AM – 10:00PM RURAL Elliot Lake 267 Hillside Drive South MON – FRI 9:00AM–5:00PM Robinson’s Medical Supplies PharmaChoice Elliot Lake, ON P5A 1N7 SAT 9:00AM – 1:00PM & Infusion (IV) Equipment & 705-848-0004 Supplies RURAL Home Hardware 275 Imperial St MON – FRI 8:00AM-6:00PM Robinson’s Medical Supplies Massey, ON P0P 1P0 SAT 8:00AM-5:00PM 705-865-2135 RURAL Home and 17 Government Road For Home and Community Care Soo Medical (Robinson’s) Community Care Wawa, ON P0S 1K0 Support Services Staff use only – Medical Supplies Support Servics 705-856-7018 Fax: 705-856-1776 Not for Patient Pick-up Wawa Office RURAL Fenlon’s Pharmacy 88 Broadway Ave. MON – FRI 10:00AM – 4:00PM Soo Medical (Robinson’s) Wawa, ON P0S 1K0 SAT 9:00AM – 2:00 PM Medical Supplies 705-856-2800 RURAL Patient Service Patients living in the defined Blind MON – FRI 8:30AM-4:30PM Robinson’s Medical Supplies Treatment Location River area are pre-authorized for & Infusion (IV) Equipment & home delivery because there is no Supplies available depot.

Deliveries during extended hours: Only available for New Patients or Patient Resumes/ Hospital Discharges/End of Life Private-Pay Patient Home Deliveries: Robinson’s to coordinate for Patients when requested

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NIPISSING-TEMISKAMING SUB-REGION (Questions or issues call: Robinson’s Pharmasave 705-495 4515 - Option 3. NOTE: For Sturgeon Falls medical supplies only call 705 566 5551 - Option 4) Service Depot/Drop-Off Availability For Regular Pick-Up Location Service Type Area Location Scheduled Patient Pick-up* URBAN Home and 1164 Devonshire Ave. For Home and Community Home and Community Care Community Care North Bay, ON P1B 6X7 Care Support Services staff Support Services Medical Supplies Support Services 705-476-2222 only – North Bay Office Fax: 705-474-2369 Not for Patient pick-up URBAN VON Ambulatory 150 First Ave. For VON Clinic Patients only Robinson’s Medical Supplies Nursing Clinic North Bay, ON P1N 3B9 705-472-8050 Fax: 705-495-6691 URBAN Robinson’s 2547 Trout Lake Road Pharmacy Hours Robinson’s Medical Supplies & Pharmasave North Bay, ON MON-FRI 9:00 AM-6:00 PM Infusion (IV) Equipment & Supplies 705-495-4515 P1B 7S8 SAT 9:00 AM -5:00 PM SUN 10:00 AM – 2:00 PM Medical Supply Depot Hours MON-SUN 9:00 AM - 6:00 PM URBAN CarePartners 195 First Ave. West, For CarePartners Clinic Robinson’s Medical Supplies & Ambulatory North Bay, ON P1B 3B8 Patients only Infusion (IV) Equipment & Supplies Nursing Clinic 1‐866‐886‐4172 URBAN Nipissing Serenity 799 John Street, For Hospice Residents Only Robinson’s Medical Supplies & Hospice North Bay, ON P1B 8T2 Infusion (IV) Equipment & Supplies 705-499-6295 RURAL Pharmacie 26 Principale Street East MON-FRI Robinson’s Medical Supplies & Nipissing Verner, ON P0H 2M0 9:00 AM - 6:00 PM Infusion (IV) Equipment & Supplies Pharmacy, 705-581-2013 PharmaChoice RURAL Mattawa IDA 300 Main Street MON-THUR 9:00AM – 5:30PM Robinson’s Medical Mattawa, ON P0H 1V0 FRIDAY 9:00AM – 6:00PM Supplies & Infusion (IV) 705-744-5981 SATURDAY 9:00AM – 5:00PM Equipment & Supplies RURAL South River 311 Hwy 124 MON-FRI 9:00AM – 5:30PM Robinson’s Medical Supplies & Pharmacy South River, ON P8A 1X0 SATURDAY 9:00AM - 2:00PM Infusion (IV) Equipment & Supplies 705-386-0636 RURAL Loblaws 12035 Hwy #17 MON-FRI 8:00AM – 9:00PM Robinson’s Medical Supplies & Pharmacy Sturgeon Falls, ON P2B 2S6 SATURDAY 9:00AM – 5:30PM Infusion (IV) Equipment & Supplies 705-753-5850 (No Frills) SUNDAY 9:00AM - 5:30PM RURAL Clement’s IDA 497 Main St MON-FRI 9:00AM – 6:00PM Robinson’s Medical Supplies & Powassan, ON P0H 1Z0 SATURDAY 9:00AM – 3:00PM Infusion (IV) Equipment & Supplies 705-724-3523 RURAL Argyle Nursing 11851 Hwy 522 MON 10:00AM – 6:00PM Robinson’s Medical Supplies 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 and Wed 16:30-17:30 RURAL Arnica Medical 162 Huston St. MON – THU 9:00AM – 5:30PM Robinson’s Medical Supplies & Pharmacy Burks Falls, ON P0A 1C0 FRI 9:00AM – 5:00PM Infusion (IV) Equipment & Supplies 705-382-2111

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

Private-Pay Patient Deliveries: Robinson’s to coordinate for Patients when requested

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NIPISSING-TEMISKAMING SUB-REGION (Questions or issues call Kirkland Lake office at 1- 888-533-2222 Ext: 3269 or call Robinson's Pharmasave 705-495-4515 (Option 3)

Service Depot/Drop-Off Availability For Pick-Up Location Service Type Area Location Regular Scheduled Pick-up* RURAL Pharmasave BDR 15 Station Rd. N MON – THURS 9:00AM – 6:00PM Robinson’s Medical Supplies Drug Mart Kirkland Lake, ON P3N 3J1 FRI 9:00AM – 8PM & Infusion (IV) Equipment & SAT 9:00AM - 5:00PM Supplies SUN 12:00PM – 4PM

RURAL J&S Variety 91 Pine Street MONDAY – FRIDAY Robinson’s Medical Supplies Store Elk Lake, ON P0J 1G0 6:00AM – 11:00PM 705-678-2246 SATURDAY & SUNDAY 7:00AM – 10:00PM RURAL Elk Lake Nursing 71 Front Street MONDAY – THURSDAY Robinsons Infusion (IV) Station Elk Lake, ON P0J 1G0 9:00AM – 3:30PM Equipment & Supplies

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

RURAL Larder Lake 15 Godfrey Street MONDAY – FRIDAY Robinsons Infusion (IV) Pharmasave Larder, Lake, ON P0K 1L0 9:00AM – 5:00PM Equipment & Supplies

RURAL Matachewan 1 Moyneur Ave MONDAY – THURSDAY Robinson’s Medical Supplies Nursing Station Matachewan, ON P0K 1M0 9:00AM – 3:00PM & 705-565-2351 Closed for Lunch 12:00 - 1:00PM

RURAL CarePartners 883361 Highway 65 N MON – FRI 8:30AM – 4:30PM Robinson’s Medical Supplies Nursing Clinic New Liskeard, ON P0J 1P0 For Clinic or and Infusion (IV) Equipment & 1-866-886-4172 ext:5351 IV Community Patients only Supplies (Pick-up on evenings/weekends by appointment only) RURAL Latchford Town 10 Main St. MONDAY – FRIDAY Robinson’s Medical Supplies Office Latchford, ON P0J 1N0 8:30AM – 4:00PM 705-676-2416 Closed 12 – 1 Daily

RURAL Temagami 17 O’Connor Dr. MONDAY – THURSDAY Robinson’s Medical Supplies Family Health Temagami, ON P0H 2H0 8:30AM – 5:00PM and Infusion (IV) Equipment & Team 705-569-3244 FRIDAY 8:30AM – 4:00PM Supplies Closed 12-1 Daily

RURAL Marshall’s 43 Third Street MON – THURS 9:00AM – 5:00PM Robinson’s Medical Supplies Pharamsave Englehart, ON P0J 1H0 FRIDAY 9:00AM – 6:00 PM and Infusion (IV) Equipment & 705-544-7878 Supplies

RURAL Cote’s Variety 16 Tenth St. E MONDAY – SUNDAY Robinson’s Medical Supplies Store Earlton, ON P0J 1E0 7:00AM – 10:00PM 705-563-2022 RURAL Bayshore 70 Esna Park Drive Unit 11 Next day delivery from Markham Bayshore Rx IV Supplies & Equipment Specialty Rx Markham, ON L3R 6E7 MON 9:00AM – 5:00PM (Only if 905-474-0822/888-313-6988 order sent on previous Friday) TUES-FRI 9:00 AM – 5:00PM

Deliveries during extended hours: Only available for New Patients or Patient Resumes/ Hospital Discharges/End of Life Private-Pay Patient Deliveries: Robinson’s to coordinate for Patients when requested

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COCHRANE SUB-REGION (Questions or issues call: 1-888-668-2222) Service Depot/Drop-Off Availability For Regular Pick-Up Location Service Type Area Location Scheduled Pick-up* URBAN Home and 330 Second Avenue, Suite 101 MON – FRI Home and Community Care Community Care Timmins, ON P4N 8A4 8:30 AM – 4:30PM Support Services Medical Support Services 705-267-2234/888-668-2222 For Staff Only Supplies Timmins Office Fax: 705-267-7795 URBAN Bayshore Home 202-119 Pine Street S MON – SUN Home and Community Care Health Clinic Timmins, ON P4N 2K3 8:00 AM – 8:00PM Support Services Medical 705-268-6088/866-227-3661 Supplies Fax: 705-268-9085 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 905-474-0822/888-313-6988 order sent on previous Friday) TUES-FRI 9:00 AM – 5:00PM RURAL Iroquois Falls Anson General Hospital MONDAY – FRIDAY Home and Community Care Office 58 Anson Drive 8:30AM – 4:30PM Support Services Medical (Due to COVID – Iroquois Falls, ON P0K 1E0 Supplies (Bayshore Rx HOME DELIVERY) 1-888-668-2222 BodyGuard IV pump Fax: 705-258-2296 available at clinic) RURAL Bingham Hospital Bingham Hospital For VON Clinic Patients only Home and Community Care (Non-clinic pts Due 507 Eight Avenue (Basement) Support Services Medical to COVID – HOME Matheson, ON P0K 1N0 Supplies (Bayshore Rx DELIVERY) 705-273-4500 BodyGuard IV pump available at clinic) RURAL Smooth Rock 133 5th Street MONDAY – FRIDAY Home and Community Care Falls Pharmacy Smooth Rock Falls, ON P0L 2B0 8:30AM – 4:30PM Support Services Medical 705-338-4470 Supplies RURAL Cochrane P.O Box 1750, 22E 5th Street MONDAY – FRIDAY Home and Community Care Office Cochrane, ON P0L 1C0 8:30AM – 4:30PM Support Services Medical (Due to COVID – 877-513-2626 ext 7300 Supplies HOME DELIVERY) Fax: 705-272-2600 RURAL Hearst PO Box 547 MONDAY – FRIDAY Home and Community Care Office 1403B Edward Street 8:30AM – 4:30PM Support Services Medical (Due to COVID – Hearst ON P0L 1N0 Supplies (Bayshore Rx HOME DELIVERY) 705-362-6633 ext 7280 BodyGuard IV pump available Fax: 705-362-6635 at clinic and office). RURAL Missinaibi-Mattice 500 Hwy 11 East MON & WED 8:30AM – 4:30PM Home and Community Care Clinic Mattice, ON P0L 1T0 TUES 7:30AM – 4:30PM Support Services Medical 705-364-2161 THURS 7:30AM – 3:30PM Supplies FRI 8:30AM – 3:30PM Closed from 12:00 – 12:30 Daily RURAL Home and PO Box 57, 48 Revillion St. MONDAY – FRIDAY Home and Community Care Community Care Moosonee ON, P0L 1Y0 8:30AM – 4:30PM Support Services Medical Support Services 705-336-2233 Supplies Moosonee Fax: 705-336-2919 Office RURAL Cavalier Motel 98 Monk Street MONDAY – FRIDAY Home and Community Care Chapleau, ON P0M 1K0 9:00AM – 7:00PM Support Services Medical 705-864-0841 Supplies

RURAL Jr Corner Store 41 Poupore St, MONDAY – SATURDAY Home and Community Care Gogama Gogama, ON, P0M 1W0 8:00AM –7:00PM Support Services Medical 705-894-2540 SUNDAY 8AM – 6PM Supplies Attention: Gogama Nursing Clinic RURAL Patient Service Patients living in the defined Home and Community Care Treatment Location Kapuskasing area are pre-authorized Support Services Medical for home delivery because there is no Supplies available depot.

Private-Pay Patient Deliveries for NE Home and Community Care Support Services Supplies: Call NE Home and Community Care Support Services for availability. Note: All IV orders from Bayshore Rx are delivered directly to the patient’s treatment location

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SUDBURY-MANITOULIN-PARRY SOUND SUB-REGION (Questions or issues call: Robinson’s Pharmasave (705-566-5551 Option 4) 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 Supplies Pharmacy Sudbury, ON P3A 1Y8 SATURDAY 9:00AM-6:00PM and IV Equipment & IV Pharmasave (705) 566-5592 SUNDAY 9:00-6:00PM Supplies URBAN Bayshore 2120 Regent Street, Unit 8 MONDAY – SUNDAY Robinson’s Medical Supplies Ambulatory Sudbury, ON P3E 5S8 8:00AM – 8:00PM and IV Equipment & IV Nursing Clinic 705-523-6668 For Bayshore Clinic Patients only Supplies

URBAN Corner Clinic 344 Elgin, Sudbury, MON – FRI 8:00AM – 2:30PM Robinson’s Medical Supplies ON P3E 3N9 (Closed between 12:00-1:00PM) 705-673-3721

URBAN Daffodil Lodge 41 Ramsey Lake Rd. MONDAY – FRIDAY Robinson’s Medical Supplies Sudbury, ON P3E 5J1 9:00AM-5:00PM

URBAN ICAN (Haig) 582 Haig Street MONDAY – FRIDAY Robinson’s Medical Supplies Sudbury, ON P3C 1C4 9:00AM-5:00PM

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

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

URBAN Health Sciences 41 Ramsey Lake Rd For Home and Community Robinson’s Medical Supplies North Sudbury, ON Care Support Services staff and IV Equipment & IV P3E 5J1 only Supplies Not for Patient pick-up URBAN Home and 40 Elm St. Suite 41-C For Home and Community Robinson’s Medical Supplies Community Care Sudbury, ON P3C 1S8 Care Support Services staff Support Staff 705-522-3460 only Sudbury Office Not for Patient pick-up

URBAN Chelmsford 46 Main St. MON–TUES 9:00AM – 9:00PM Robinson’s Medical Supplies Guardian Chelmsford, ON P0M 1L0 WED-FRI 9:00 AM – 7:00PM Pharmacy 705-855-2371 SATURDAY 9:00AM – 5:30PM URBAN Sudbury Steam 1769 Regent Street MON – FRI 8:00AM – 6:00PM Robinson’s Medical Supplies Sudbury, ON P3E 3Z7 SATURDAY 9:30AM – 5:30PM 705-522-1415

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

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

Deliveries during extended hours: Only available for New Patients or Patient Resumes/ Hospital Discharges/End of Life Private-Pay Patient Deliveries: Robinson’s to coordinate for Patients when requested

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SUDBURY-MANITOULIN-PARRY SOUND SUB-REGION (Questions or issues call: Robinson’s Pharmasave (705-566-5551 Option 4)

Service Depot/Drop-Off Availability For Pick-Up Location Service Type Area Location Regular Scheduled Pick-up* URBAN Lalonde Pharmacy 23 Yonge St. MON-THURS 9:00AM – 5:30PM Robinson’s Medical Supplies Capreol, ON FRIDAY 9:00AM – 6:00PM 705-858-1231 SATURDAY 10:00AM – 3:00PM

URBAN Dowling Pharmacy 30 Main St. MON – FRI 9:00AM – 6:00PM Robinson’s Medical Supplies Dowling, ON SATURDAY 9:00AM – 5:30PM 705-855-4562

URBAN Levack Pharmacy 2 – 1st Ave North MONDAY – FRIDAY Robinson’s Medical Supplies Onaping Falls, ON 9:00AM - 5:00PM 705-966-3612

RURAL Hagar General 7147 Hwy 17 E, MON – FRI 8:00AM – 7:00PM Robinson’s Medical Supplies Store Hagar, ON SATURDAY 9:00AM – 7:00PM 705-207-1006 SUNDAY 9:00AM – 5:00PM

RURAL Noelville 27 St David N, MON-THURS 9:00AM – 5:30PM Robinson’s Medical Supplies Pharmacy Noelville, ON P0O 2N0 FRIDAY 9:00AM – 6:00PM and IV Equipment & IV 705-898-2999 Supplies SATURDAY 9:00AM – 4:00PM

RURAL St. Charles 25 Main St. MON-SAT 8:00AM – 7:00PM Robinson’s Medical Supplies Cooperative Store St. Charles, ON SUNDAY 9:00AM – 6:00PM 705-867-2000

RURAL Pitfield General 7 Channel MON – SUN 7:00AM – 7:00PM Robinson’s Medical Supplies Store Killarney, ON P0M 2A0 705-287-2872

RURAL Robinsons 119 Tudhope MON-FRI 9:00AM – 5:00PM Robinson’s Medical Supplies Pharmasave Espanola, ON SATURDAY 10:00AM – 2:00PM and IV Equipment & IV 705-869-1561 Supplies

RURAL Home Hardware 275 Imperial St MON – FRI 8:00AM – 6:00PM Robinson’s Medical Supplies Massey, ON P0P 1P0 SATURDAY 8:00AM – 5:00PM 705-865-2135

RURAL Little Current 41 Meredith St MON-THURS 9:00AM – 5:30PM Robinson’s Medical Supplies Guardian Little Current, ON P0P 1K0 FRIDAY 9:00AM – 7:00PM and IV Equipment & IV 705-368-2530 SATURDAY 9:00AM – 5:30PM Supplies SUNDAY 10:00AM – 2:00PM

RURAL Manitowaning 1 Wellington MONDAY – SATURDAY Robinson’s Medical Supplies Pharmacy Manitowaning, ON P0P 1N0 9:00AM – 5:30PM 705-859-2323

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

RURAL Central Guardian 45 Meredith Street MONDAY – SATURDAY Robinson’s Medical Supplies Pharmacy Gore Bay, ON P0P 1H0 9:00AM – 5:30PM 705-282-2409

Deliveries during extended hours: Only available for New Patients or Patient Resumes/ Hospital Discharges/End of Life

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Private-Pay Patient Deliveries: Robinson’s to coordinate for Patients when requested SUDBURY-MANITOULIN-PARRY SOUND SUB-REGION (Questions or issues call: Robinson’s Pharmasave (705-566-5551 Option 4)

Service Depot/Drop-Off Availability For Regular Pick-Up Location Service Type Area Location Scheduled Pick-up* RURAL Britt Nursing Box 75 MON - THURS 8:00AM-4:00PM Robinson’s Medical Supplies Station 987 Riverside Dr. (closed for lunch 12 – 1) Britt, ON P0G 1A0 FRIDAY 8:00AM-12:00PM 705-383-2375

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

RURAL Lane Family 4 Pine Parry Sound MON - FRI 8:30 – 6:00PM Robinson’s Medical Supplies & Pharmasave Parry Sound, ON P2A 3B8 SATURDAY 8:30 – 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 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 Home and 6 Albert Street For Home and Community Robinson’s Medical Supplies Community Care Parry Sound, ON P2A 3A4 Care Support Services staff Support Services only West Parry Sound Not for Patient pick-up Home and Community Care Hospital Support Services Medical Supplies

Deliveries during extended hours: Only available for New Patients or Patient Resumes/ Hospital Discharges/End of Life Private-Pay Patient Deliveries: Robinson’s to coordinate for Patients when requested

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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.healthcareathome.ca/northeast www.healthcareathome.ca/northeast