Mississauga Halton Community Care Access Centre

Home and Community Care Referral Form

NEW Referral Form for Home and Community care
The Mississauga Halton CCAC Medical Referral has changed. The previous form (Form # CS ACCESS 001) has been updated and is now called the “Mississauga Halton CCAC Home and Community Care Referral Form”. The form now more accurately reflects care in the community and provides more information about care options, and details around medical orders.
What is new?
The new Mississauga Halton CCAC Home and Community Care Referral form has been updated to include additional information that helps us put together the plan of care without having to call back for additional information
The new form has additional resources added including Health Links which will allow for quicker access to care
The form is now “fillable” which means you can complete it electronically, print and fax it to our office
This form is available on our website
Tips for Making a Referral to the Mississauga Halton CCAC:
Referrals to the Mississauga Halton CCAC can be made by any member of the health care team. Early identification of patients who require health care at home or in the community helps to ensurepatients get the care and support needed to remain safe at home and avoid a potential trip to Emergency Department, hospital admission or move to Long Term Care.
All referrals require a “Home and Community Care Referral Form” (formerly referred to as the Medical Referral or MR) to be completed and faxed to the Mississauga Halton CCAC Office.
Physician signature is required ONLY for nursing and physiotherapy weight bearing status.
A complete referral means all information received at time of referral will ensure patients get the right care when they need it. /
Reminder for physicians:
The billing codes you can use for care:
  • K070 for completing a CCAC referral
  • K071 and K072 for acute and chronic home care supervision (for personally providing medical advice, direction or information to CCAC or delegated health-care staff)
  • K124 for a case conference regarding a CCAC patient

October 6, 2016