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My Hospital Form

My Hospital Form

Introduction

The Hospital Form is designed for family and other caregivers of adults with intellectual and developmental disabilities. In the event of a hospital admission, this form communicates essential information to hospital staff, including medical information, substitute decision-maker contacts and information about support needs. It promotes the accommodation of a person’s unique communication and behavioural support needs in health care. It is recommended to prepare this form in advance of an emergency and have it available upon a transfer to the hospital.

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How to prepare for a COVID-19 hospital visit


This tool was originally developed as the COVID019 Hospital Transfer Form , in response to the COVID-19 Pandemic by the Developmental Disabilities Primary Care Program of Surrey Place, Toronto, 2020. The content of this tool was subject to review by Surrey Place clinicians, primary care providers and other relevant stakeholders. Special acknowledgement of the invaluable contributions by Dr. Yona Lunsky, Director of the Azrieli Adult Neurodevelopmental Centre, and Senior Scientist at the Centre for Addiction and Mental Health, Toronto, and Dr. Ullanda Niel, family physician with special training in the care of adults with developmental disabilities from Queen’s University.

  • Materials

    How to prepare for a COVID-19 hospital visit


  • Version history

    This tool was originally developed as the COVID019 Hospital Transfer Form , in response to the COVID-19 Pandemic by the Developmental Disabilities Primary Care Program of Surrey Place, Toronto, 2020. The content of this tool was subject to review by Surrey Place clinicians, primary care providers and other relevant stakeholders. Special acknowledgement of the invaluable contributions by Dr. Yona Lunsky, Director of the Azrieli Adult Neurodevelopmental Centre, and Senior Scientist at the Centre for Addiction and Mental Health, Toronto, and Dr. Ullanda Niel, family physician with special training in the care of adults with developmental disabilities from Queen’s University.