Pour plus d'informations sur le programme For more information on the program
Designated Care Partner Registration Form
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Imprimer/Print
Bruyère - Partenaire en soins désigné (bruyere.org)
Soumettre/Submit
Email Address
Designated Care Partner Name
No description
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Phone
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Admission Date
Patient Name
Campus
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Hôpital Elisabeth Bruyère Hospital
Résidence Elisabeth Bruyère Residence
Hôpital Saint Vincent Hospital
Résidence Saint Louis Residence
Selection
No description
No description
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Oui/Yes
Non/No
I will follow Bruyère’s infection prevention policies.
I will follow Bruyère’s COVID-19 testing policies.
Oui/Yes
Non/No
The patient is aware of my request to become a designated care partner.
Oui/Yes
Non/No
I will do the designated care partner training program.
Oui/Yes
Non/No
I am 18 years of age or older
Oui/Yes
Non/No
I will commit to five hours per week
A maximum of two Designated Care Partners (DCP) are permitted per patient.
Bruyère - Designated Care Partner (bruyere.org)
Suivant/Next >>
For testing purposes only. Enter your email address here >> so that the request will be emailed to you. When the form is live, this will be hidden and the reequest sent to the TBD mailbox for the DCP program group
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