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There are numerous clinical programs at The Ottawa Hospital which offer patients the option to have some appointments via Telemedicine

Please select from the list of programs below to access the quick reference protocol, other clinical documents required by the service and patient information resources.

Standard Telemedicine Worksheet

• Worksheet for Standard Telemedicine Worksheet
  for Standard Telemedicine Worksheet

Cardiology Clinic

• Protocol for Cardiology Clinic
• Worksheet
• Cardiology Clinic Referral Form

Cardiology-Electrophysiology Clinic

• Protocol for Cardiology- Electrophysiology Clinic
• Worksheet for Cardiology- Electrophysiology Clinic
• Referral Form Arrhythmia for Cardiology- Electrophysiology Clinic
• Referral Form Pacemaker (ICD)
• Heart Institute – Telemedicine Referral FormHeart Institute – Telemedicine Referral FormHeart Institute – Telemedicine Referral FormHeart Institute – Telemedicine Referral FormHeart Institute – Telemedicine Referral FormHeart Institute – Telemedicine Referral Form for Cardiology- Electrophysiology Clinic

Eating Disorders Clinic

• Protocol for Eating Disorders Clinic
• Worksheet for Eating Disorders Clinic

Epilepsy Clinic

• Protocol for Epilepsy Clinic
• Worksheet for Epilepsy Clinic
• Epilepsy Clinic New Patient Intake Form for Epilepsy Clinic
• Epilepsy Clinic Return Patient Intake Form for Epilepsy Clinic

Hematology Clinic

• Protocol for Hematology Clinic
• Worksheet for Hematology Clinic

Hepatitis C Clinic

• Protocol for Hepatitis C Clinic
• Worksheet for Hepatitis C Clinic
• Nursing Intake Form (for new consults only – 30 min) for Hepatitis C Clinic

HIV Pre-Exposure Prophylaxis Clinic

• Protocol for HIV Pre-Exposure Prophylaxis Clinic
• Worksheet for HIV Pre-Exposure Prophylaxis Clinic

Hyperbaric Chamber Clinic

• Protocol for Hyperbaric Chamber Clinic
• Worksheet for Hyperbaric Chamber Clinic

Infectious Diseases Clinic

• Protocol for Infectious Diseases Clinic
• Worksheet for Infectious Diseases Clinic

Liver and Pancreas Clinic

• Protocol for Liver and Pancreas Clinic
• Worksheet for Liver and Pancreas Clinic
• Pre-Op Health History Questionnaire for Liver and Pancreas Clinic

Oncology Clinic

• Protocol for Oncology-RPALL Clinic
• Telemedicine Worksheet
• Edmonton Symptom Assessment Scale (ESAS)

Oncology-RPALL Clinic

• Protocol for Oncology-RPALL Clinic
• Worksheet for Oncology-RPALL Clinic
• Edmonton Symptom Assessment Scale (ESAS)-bilingual for Oncology-RPALL Clinic
• Brief Pain Inventory (BPI)

Palliative Care Clinic

• Protocol for Palliative Care Clinic
• Worksheet for Palliative Care Clinic
• Brief Pain Inventory (BPI) for Palliative Care Clinic
• Distress Thermometer for Palliative Care Clinic
• Edmonton Symptom Assessment Scale (ESAS)-bilingual for Palliative Care Clinic
• Global Nutrition Assessment Form (PG-SGA) for Palliative Care Clinic
• Palliative Performance Scale Functional Assessment for Palliative Care Clinic

Pain Clinic

• Protocol for Pain Clinic
• Appointment day documents (to be completed by the patient for every visit) for Pain Clinic
• Pain History Questionnaire (for new consults only-60 min) for Pain Clinic

Pre-Admission Clinic (PAU)

• Protocol for Pre-Admission Clinic (PAU) Clinic
• Worksheet for Pre-Admission Clinic (PAU) Clinic

Radiation Oncology Clinic – Stage 1 Lung Cancer

• • Protocol for Radiation Oncology Clinic- Stage 1 Lung Cancer

• Edmonton Symptom Assessment Scale (ESAS)-bilingual for Radiation Oncology Clinic- Stage 1 Lung Cancer
• Palliative Performance Scale Functional Assessment for Radiation Oncology Clinic- Stage 1 Lung Cancer

Respirology – Interstitial Lung Disease Clinic

• Protocol for Respirology – Interstitial Lung Disease Clinic
• Worksheet for Respirology – Interstitial Lung Disease Clinic

Rheumatology

• Protocol for Rheumatology
• Worksheet for Rheumatology

Thoracic Surgery Clinic

• Worksheet for Thoracic Surgery Clinic

Vascular Surgery Clinic

• Protocol
• Worksheet

Last updated on: September 21st, 2021