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Champlain Complex Care Program

Referral Form and Criteria Info

The program accepts referrals from Physicians and NursePractitioners.

 

We Accept Referrals:

We Do Not Accept Referrals:

  • Multicomplex child (see complexity criteria)
  • Medically fragile (see fragility criteria)
  • Dependency on high intensity care/technological device
  • Has an existing risk of an unexpected severe acute life-threatening event.
  • Has or is at risk of having a mental health
    diagnosis
  • Between the age of 0 years and 16 years of age at by the date of admission
  • Child is under the care of a family physician
  • Child requires care co-ordination as a result of complexity.
  • Child resides in the Champlain Local Health Integrated Network (LHIN) and uses the services of CHEO and/or Community Programs.
  • Child is over 16yrs of age at date of
    admission
  • The medical condition(s) of the child fit into a pre-existing team of health care providers offering coordination of care between all required service providers (example: Eating Disorders OPT, Psychology, Psychiatry, Dermatology, PT/OT, Cystic Fibrosis Rehab Med, Spina Bifida, Oncology, Down Syndrome Clinic, Neuromuscular clinic).
 

PDF symbolPlease click here for complete Inclusion/Exclusion Criteria and Definitions.

PDF symbolPlease click here for the Program Referral Form.

PDF symbolDownload the Champlain Complex Care Program Fact Sheet

Please mail or fax the referral form to:

Champlain Complex Care Program
Attention: Corporate Patient Services, room 2011
Children’s Hospital of Eastern Ontario
401 Smyth Rd.
Ottawa, ON K1H 1L1
FAX: 613-738-4251

For more information, please visit the Champlain Complex Care section of this website

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