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Health Care Provider Resources and Order Form

DurhamMD

Connecting Durham Region Health Care Providers to free resources to assist them in their daily practice.

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Download Forms - For Health Care Provider Use Mouse Icon

Item

 

Animal Bite/Exposure Reporting Form Download PDF
Cancer Screening Resources Order Form Download PDF
Tobacco Free Resource Order Form Download PDF
Breastfeeding Services Referral Form Download PDF
Ontario Medications Return Program and Ontario Sharps Collection Program - Promo Order Form Download PDF

Immunization

AEFI Report Form Download PDF
Immunization Record Update Form Download PDF
Menactra, Menomune, MenB Order Form Download PDF
Special Release for Hep A Vaccine Request Form Download PDF
Special Release for Hep B Vaccine Request Form New Download PDF
HPV4 (Human Papillomavirus 4 Vaccine) Request Form New Download PDF
HPV9 (Human Papillomavirus 9 Vaccine) Request Form New Download PDF
Special Release for Act-Hib Vaccine Request Form Download PDF
Special Release for Td-IPV Vaccine Request Form Download PDF
Vaccine Order Form Download PDF
Requisition for Menactra® Vaccine Batch Orders New Download PDF
Vaccine Return Form Download PDF
Vaccine Cold Chain Inventory Worksheet Download PDF

Influenza Vaccine Order Form

2017/2018 Influenza Vaccine Order Form New Download PDF

Statement of Medical Exemption Forms

Parent/Guardian of Child Attending Child Care
Select "Parent of a child"
Download PDF
Child Care Staff
Select "An individual"
Download PDF
Student Attending School Download PDF

Edinburgh Postnatal Depression Scale

Instructions Download PDF
Assessment Tool Download PDF
Perinatal Mood Disorders (PMD) Peer Support Group Referral Form Download PDF

Enhanced 18-month Well-Baby Visit Pathway

Durham Region Enhanced 18-month Well-Baby Visit Pathway: Community Resource Guide for Children 0-6 Download PDF
Durham Region Community Support Checklist Referral Options Download PDF

Resources Mouse Icon

Item

Details

Number Ordered

Chronic Disease Prevention - Cancer Screening

Breast Cancer Screening (Mammograms) Durham Region Health Department PDF

Pamphlet

(max 50)

Cancer Screening & Prevention PDF

Pamphlet

(max 50)

Cancer Screening Reminder Card PDF

Pamphlet

(max 50)

Cervical Cancer Screening (Pap Tests) PDF

Pamphlet

(max 50)

Colon Cancer Screening Pamphlet PDF

Pamphlet

(max 50)

How can you protect YOURSELF from cervical cancer? PDF

Pamphlet

(max 50)

HPV... It Could Happen to You PDF

Pamphlet

(max 50)

Pap Test Survival Guide PDF

Pamphlet

(max 50)

10 Reasons to (Love) Your Pap PDF

Pamphlet

(max 50)

Chronic Disease Prevention - Food Security

Food Budget Kit

The Food Budget Kit was created to help families eat healthy when on a budget.  It includes information and tools to help learn about menu planning, smart shopping, following Canada’s Food Guide, cooking at home and using leftovers.

(max 1)

Chronic Disease Prevention - Healthy Eating and Nutrition

Food Skills Kit

How to make eating fruit and vegetables easy, affordable and enjoyable. This kit includes:

  • guide to fruit and vegetables
  • quick and easy recipe cards

(max 1)

Plate-Scaping... A Fresh Take on a Balanced Meal PDF

Learn how to eat healthier by deciding which foods are needed to make a balanced meal or snack. Booklet.

(max 30)

Pack Some Wow In Your Lunch PDF

Learn more about making healthy snacks and lunches (all ages). Booklet.

(max 30)

Take Small Steps to Healthier Eating (8½" x 11") PDF

Eat together with friends and family as often as possible. Poster.

(max 30)

Eat a healthy breakfast everyday. Poster.

(max 30)

Drink water to satisfy your thirst. Poster.

(max 30)

Eat one more fruit and vegetable each day. Poster.

(max 30)

Small Steps to Healthier Eating Checklist PDF

A resource with small changes you can start today to eat healthier (for adults).

(max 30)

Vegetable and Fruit Recipes PDF

A set of 5 different recipes

(max 30)

Together is Better! Eating Healthy as a Family Magazine PDF

Learn to eat healthy as a family.

(max 1)

Together is Better! Eating Healthy as a Family magazine. Love Your Breakfast Edition! PDF

Learn to eat healthy as a family.

(max 30)

Together is Better! Bringing Tradition Back to the Table. PDF

Learn to eat healthy as a family.

(max 30)

How Do Fats Measure Up? PDF

This pamphlet explains ‘healthy fats’ and ‘unhealthy fats’; how much fat you should consume; and helps you to make healthy choices for you and your family.

(max 30)

Your Menu for Healthy Eating Out PDF

This pamphlet will give you practical tips and useful tools to help you make healthy choices while eating out.

(max 30)

Rethink Your Drink PDF

This resource provides tips on making healthy drink choices. Pamphlet.

(max 30)

Vegetable and Fruit Workplace Toolkit

This resource aims to encourage employees to eat more vegetables and fruit.

(max 1)

Vegetable and Fruit Workplace Toolkit Table Toppers PDF

Table Toppers

(max 3)

Small Steps to Reduce Your Sodium Posters (8½" x 11") PDF

Get fresh when you can.

(max 30)

Give sodium the 'rinse'. Drain and rinse canned foods.

(max 30)

Use the nutrition facts table. Choose lower sodium foods.

(max 30)

Food Label Reading Made Easy PDF

This resource will help you read labels on food packages and choose lower sodium options.

(max 30)

Where's the Salt? PDF

This pamphlet will provide tips to reduce your salt intake.

(max 30)

Workplace Toolkit for Sodium Reduction

This toolkit can be used to:

  • Increase knowledge and raise awareness about sodium reduction
  • Share ideas and tips on how to eat less salt

Contains:

  • Small Steps to reduce your Sodium posters (set of 3)
  • Ready to use newsletter inserts and snack recipe
  • Messages for Emails or Paystubs
  • Link to Sodium IQ on-line Quiz
  • What’s in That Dish? Fast Food IQ Quiz

(max 1)

Chronic Disease Prevention - Healthy Weights

Small Steps To A Healthier Weight PDF

A resource with small changes you can start today to achieve and maintain a healthier weight (for adults). Booklet.

(max 30)

Healthier Weights Posters (set of 5 posters) PDF

These posters provide different tips for adults to achieve and maintain a healthier weight

(max 1 set)

Healthy Sleep Healthy Me PDF

A resource explaining the important role parents/caregivers play in helping their school aged children (4-12 years) develop healthy sleep routines.

(max 25)

Creating Healthy Routines PDF

This resource helps families to create healthy routines through eating healthy, being active, and getting enough sleep.

(max 25)

Mental Health

Mental Health is for Everyone - booklet PDF

A resource promoting mental health

(max 25)

Mental Health is for Everyone - postcard PDF

Promotes the Mental Health is for Everyone booklet

(max 50)

Mental Health is for Everyone - poster PDF

Promotes the Mental Health is for Everyone booklet

(max 5)

Mental Health is for Everyone - tear off PDF

Promotes the Mental Health is for Everyone booklet (25 tear-offs per pad)

(max 2)

Teens Can Be Resilient! A Parent's Guide PDF

A resource for parents of teens on building resiliency

(max 10)

Teens Can - postcard PDF

Promotes Teens Can resources for parents

(max 50)

Teens Can - poster PDF

Promotes Teens Can resources for parents

(max 5)

Teens Can Be Resilient... in High School! A Parent's Guide PDF

A resource for parents of teens transitioning into high school

(max 10)

Teens Can Be Resilient... in High School! A Parent's Guide - postcard PDF

Promotes the Teens Can Be Resilient... in High School! A Parent's guide resource

(max 50)

Growing Resilient Children pamphlet PDF

A resource for parents of children 7-12

(max 10)

Kids Can magazine PDF

A resource for parents of children ages 0-6 on building resilient kids

(max 10)

Kids Can postcard PDF

Promotes Kids Can resource for parents

(max 50)

Be Safe - poster - English PDF

Promotes an app that supports youth in making a crisis safety plan and accessing crisis resources

(max 5)

Be Safe - poster - French PDF

Promotes an app that supports youth in making a crisis safety plan and accessing crisis resources

(max 5)

Chronic Disease Prevention - Physical Activity

Children's Activity Catcher PDF

Interactive game for children

(max 25)

Fall/Winter Poster PDF

Encourages walking for adults

(max 5)

Spring/Summer Poster PDF

Encourages walking for adults

(max 5)

Family Activity Guide: Get your family moving PDF

Interactive tools for parents

(max 25)

Move and Play Everyday! PDF

Resource for parents full of tips and games to encourage daily physical activity

(max 25)

Adult Physical Activity Resource Card PDF

Interactive tip card for adults 18-65

(max 25)

Physical Activity Planner (Child 5 - 11) PDF

Interactive resource to encourage meeting physical activity guidelines

(max 25)

Physical Activity Planner (Youth 12 - 17) PDF

Interactive resource to encourage meeting physical activity guidelines

(max 25)

Physical Activity Planner (Adult 18 and older) PDF

Interactive resource to encourage meeting physical activity guidelines

(max 25)

Physical Activity Wallet Tracker PDF

Interactive tool for adults to make a plan to build activity into each day

(max 25)

Stand Up for Your Health Booklet PDF

A resource to encourage adults to break up sedentary time

(max 25)

Sedentary Time and Your Health PDF

Fact sheet

(max 25)

Walking Booklet PDF

Interactive resource for adults to encourage daily physical activity

(max 25)

Chronic Disease Prevention - Sun Safety

Infant Postcard PDF

Postcard

(max 30)

Sun Safety Information Sheet PDF

Information Sheet

(max 30)

Tanning Bed Fact Sheet PDF

Fact Sheet

(max 30)

Chronic Disease Prevention - Tobacco Free Living

Brief Contact Intervention (BCI) Provider Information Health Care Provider Resource

Information Sheets

Health Care Settings (max 5)

Primary Health Care Providers (max 5)

Youth and Young Adult Population (max 5)

Mental Health and/or Addictions Population (max 5)

Pregnant and Postpartum Population (max 5)

Aboriginal Peoples (max 5)

BCI Smoking Cessation Posters Health Care Provider Resource

Posters

  • Set of 5 posters
  • Back to Basics "Thank you for making Ontario Smoke-Free"
  • Smoke-Free Homes
  • Smoke-Free Cars
  • Quit Smoking "You Have Options... We Can Help"
  • Health Care Providers (5As)

(max 2)

How Does the Smoke Know Where to Stop?

Second hand smoke pamphlet

(max 25)

Smoking Cessation for Young Adults

Smoking cessation for young adults. Includes 5 posters and 5 postcards

(max 2)

Smoke-Free Cars Package

Includes pamphlet and "no smoking decal"

(max 2)

Smoke-Free Cars

Pamphlet

(max 25)

Smoke-Free Cars

Tear-off pad. 50 sheets per pad.

(max 2)

Smoke-Free Homes Package

Includes pamphlet and window cling

(max 2)

Smoke-Free Home

Pamphlet

(max 25)

Smoke-Free Home

Tear-off pad. 50 sheets per pad.

(max 2)

Starting a Smoke-Free Life

Pamphlet for pregnant/postpartum women

(max 25)

8 Tips to Quit Smoking

Tear-off pad. 50 sheets per pad.

(max 2)

Options to help you quit smoking

Community supports pamphlet

(max 25)

Family Health - Breastfeeding/Nutrition

Breastfeeding Welcome Here! Poster PDF Health Care Provider Resource

Letter sized poster displayed in your establishment demonstrates support for a mother’s right to breastfeed her baby Anytime Anywhere. Ideal for waiting room bulletin boards and display cases.

(max 25)

Breastfeeding Welcome Here! Window Cling/Decal PDF Health Care Provider Resource

Window cling/decal displayed in a window of your establishment demonstrates support for a mother’s right to breastfeed her baby Anytime Anywhere. (Size 11.5 x 11.5 cm/ 4.5” x 4.5”)

(max 25)

Breastfeeding Resource Card (yellow) PDF

A comprehensive listing of breastfeeding resources and services available throughout Durham Region. (Updated annually).

(max 25)

Gets the Facts on... Breastfeeding card PDF

A resource for prenatal and breastfeeding clients on the facts/benefits of breastfeeding and to help them make an informed decision on the use of formula.

(max 25)

Prenatal Breastfeeding Package

Information package focused on knowing what the signs of successful breastfeeding are and knowing when and where to get help before baby is born, to increase a new mother's confidence and make all the difference.

(max 25)

Telehealth Ontario 24/7 Breastfeeding Support PDF

A pamphlet that describes the supports which are available to new and expectant moms

(max 25)

Feeding Your Baby from Six Months to One Year PDF

A booklet designed to help parents introduce their infants to solid food.

(max 25)

WHO Growth Charts for Girls & Boys

WHO growth charts, adapted for Canada, are recommended for monitoring and assessment of growth of Canadian infants and children.

Boys Birth - 6 mths (max 25)

Girls Birth - 6 mths (max 25)

Boys Birth - 24 mths (max 25)

Girls Birth - 24 mths (max 25)

Family Health - Preconception/Prenatal

Baby on the Way? Call us Today... Resource Inventory PDF

A booklet with a current, comprehensive listing of community resources and services to support healthy preconception and prenatal care in Durham.

(max 25)

Due Date Calculator

Calculator that outlines fetal development, including health messages and highlights services available from the Health Dept. related to preconception and pregnancy.

(max 25)

Health Before Pregnancy Makes a Difference Package

An information package for women and men who are planning a pregnancy or just thinking about it. The package includes information on folic acid, Men’s preconception health, pregnancy after 35, alcohol free pregnancy, etc.

(max 25)

Online Prenatal Classes Bookmark PDF

Bookmark promoting free online prenatal classes available here covering: healthy lifestyles, prenatal tests, common discomforts, fetal development, complications, labour and delivery, postpartum care and newborn care.

(max 25)

Sexually Transmitted Infections in Pregnancy PDF

Pamphlet describing STI’s that can adversely affect pregnancy.

(max 25)

SMILE Prenatal Classes Tear off Pad PDF

Tear-offs promoting free labour and delivery classes for pregnant women under the age of 23 and their birth partners. (50 sheets/pad)

(max 1)

Family Health - Parenting

Early Identification and Treatment of Developmental Concerns in Children 0-6 flow chart Health Care Provider Resource

This referral flow chart provides a list of Durham Region services and contact numbers to ensure that the enhanced 18-month well-baby visit is delivered consistently

(max 5)

Adjusting to Parenthood PDF

Pamphlet on what parents can expect as they adjust to parenthood, including the many changes and practical tips for expectant and new parents

(max 25)

Car Seat Safety Checklists

Tear-off checklists that highlight some basic car seat installation steps and checks.  Checklists are available for: Infant Car Seat, Child Car Seats and Booster Seats. 25 Sheets per pad.

Infant (max 10)

Child (max 10)

Booster (max 10)

Connecting with Your Child Resource Cards

Resources highlighting strategies to help parents connect with their children to foster/maintain attachment from prenatal up to 18 yrs of age

Prenatal (max 25)

Birth to 2 Years (max 25)

3-5 Years (max 25)

6-12 Years (max 25)

13-18 Years (max 25)

Crying Baby - Handle with Care PDF

Information pamphlet on why babies cry and soothing tips. Includes information on attachment and "shaken baby"

(max 25)

Grandparents Can Make a Difference! PDF

A resource pamphlet and web page available especially for grandparents. The resources acknowledge the important role that grandparents play in families and include tips on enhancing the grandparent/grandchild relationship and links to child health information to help grandparents keep current.

Directs grandparents to the online grandparent resources which provide current child health information and other tips

Pamphlets (max 25)

Tear-Off Pad (max 1)

Growth and Development Resources

These growth and development cards are a parent resource designed to increase awareness of developmental milestones.

(max 25 total)

2 months

4 months

6 months

9 months

12 months

15 months

18 months

2 years

3 years

4 years

5 years

Healthy Babies Healthy Children (HBHC) Tear-off pad PDF

Tear-offs promoting free labour and delivery classes for pregnant women under the age of 23 and their birth partners. (50 sheets/pad)

(max 1)

Healthy Babies Healthy Children (HBHC) Poster with Tear-off pad PDF

A poster promoting HBHC Program which includes tear-offs for clients to self-refer. (50 sheets/pad)

(max 2)

Home Should Be A Safe Place Pamphlet PDF

Pamphlet raising awareness related to the effects of violence on children and highlighting services available for families affected by family violence

(max 25)

How is your child developing? Endds.ca PDF

A tear-off pad to give to parents to remind them about registering their child with endds.ca to receive free electronic Nipissings to track child development. (50 sheets/pad)

(max 2)

I didn't think it would be like this! (PMD) PDF

Pamphlet describing the symptoms, risk factors and treatment options for Perinatal Mood Disorders and community supports available.

(max 25)

Does Someone You Care about have a Perinatal Mood Disorder? PDF

Pamphlet explains Perinatal Mood Disorder and outlines ways that family and friends can provide support.

(max 25)

Taking Care of Yourself - Wallet card PDF

Wallet card with self-care tips and information on community supports if experiencing symptoms of Perinatal Mood Disorder.

(max 25)

Mental Health Services in Durham Region PDF

A wallet-sized booklet with a listing of mental health community resources and services to support families in Durham Region.

(max 25)

Nipissing District
18 months Developmental Screen
PDF

A checklist to help monitor child development. Includes a list of age appropriate activities for 18-month olds to encourage parent involvement. (50 sheets/pad)

(max 2)

Positive Discipline Resources PDF

These resources, created by the Positive Discipline Coalition of Durham Region, provide information about what behaviours to expect at ages 0-18 years and offer positive discipline strategies to enhance parenting skills. Tear off pads and poster (8x11) provide contact information for parents or caregivers to request a free copy of the resource.

English (max 25)

French (max 25)

Pads (max 25)

Posters (max 25)

Tummy Time booklet PDF

Booklet encouraging parents/caregivers to provide babies with regular tummy time to foster head and neck muscle development.

(max 25)

Your child’s enhanced 18-month well-baby visit

Provincial pamphlet for families describing what to expect during the enhanced 18-month well-baby visit. Available in sixteen different languages.

(max 25)

Sleep Well Sleep Safe PDF

A booklet that provides information about healthy and safe sleep practices for infants 0 -12 months.

(max 25)

Immunization

Immunization Record Update Health Care Provider Resource

Tear-Off Pad

(max 25)

A Parent’s Guide to Vaccination PDF

 

(max 25)

Infectious Diseases Prevention & Control

Reportable Disease List PDF Health Care Provider Resource

The following diseases are reportable to the local Medical Officer of Health, BOLDED diseases must be reported immediately.  All other diseases may be reported on the next day of work.

(max 25)

THINK TB! PDF Health Care Provider Resource

Recognize the signs & symptoms of tuberculosis (TB).  TB is preventable, treatable, & curable!

(max 25)

Medical Surveillance for Tuberculosis (TB)

Information for people who have a history of TB and are entering Canada

(max 25)

Together we can STOP TB PDF

Information regarding Tuberculosis

(max 25)

Tuberculosis - Know the Difference PDF

Resource showing the difference between TB Infection and TB Disease

(max 25)

Injury Prevention - Child Safety

Keeping Kids Safe Booklet PDF

Information for parents of children 0-4 years on preventing child injuries in the home. Includes a Child Home Safety Checklist

(max 25)

Injury Prevention - Concussions & Sports Injuries

Concussion Prevention Posters PDF

Posters (Set of 6)

  • Which brain has a concussion?
  • Concussions can keep you from playing sports
  • Concussions are brain injuries
  • Concussions can prevent you from doing fun things (2)
  • Concussion can keep you from playing sports

(max 6)

Heads Up on Concussions: What Parents Need to Know PDF

Resource for Parents

  • Helps parents to recognize and manage concussions in children and youth
  • Includes 'Return to Learn' and 'Return to Play' Guidelines

(max 25)

Injury Prevention & Chronic Disease Prevention - Healthy Active Aging

Feeling Good Magazine PDF

A resource for adults 50+

(max 25)

Radiation Protection and Potassium Iodide (KI) Tablets

Potassium Iodide (KI) Tablets PDF

A pamphlet explaining what KI is, dosage, when to take, etc...

(max 20)

Sexual Health

Am I Ready PDF

Information on Healthy Relationships

(max 50)

Birth Control... What's Right for You? Booklet

Forms of birth control and what you should know…

(max 50)

Chlamydia & Gonorrhea Infections Tear - Off Pads

Information sheet for clients

(max 50)

Facts About... Tear-Off Pads

Birth Control Pill

(max 2)

Male Condom

(max 2)

Female Condom

(max 2)

Vaginal Ring

(max 2)

Transdermal Patch

(max 2)

Progestin-Only Injectable

(max 2)

Spermicide

(max 2)

Abstinence

(max 2)

Intrauterine Device (IUD)

(max 2)

Emergency Contraceptive Pill (ECP)

(max 2)

Pap Test or Swab

(max 2)

Hepatitis B Vaccine

(max 2)

Hepatitis A

(max 2)

Hepatitis B

(max 2)

Hepatitis C

(max 2)

HIV/AIDS

(max 2)

Chlamydia

(max 2)

Gonorrhea

(max 2)

Genital Warts

(max 2)

Human Papillomavirus (HPV) Vaccine

(max 2)

Yeast

(max 2)

Syphilis

(max 2)

Genital Herpes

(max 2)

Bacterial Vaginosis

(max 2)

Molluscum Contagiosum

(max 2)

Pubic Lice

(max 2)

Trichomoniasis

(max 2)

Human Papillomavirus (HPV)

(max 2)

Lymphogranuloma Venereum (LGV)

(max 2)

Sexual Health Clinics Pamphlet PDF

  • Lists Services Provided
  • Clinic Locations & Phone Numbers

(max 50)

Sexual Health Clinic Tear-Off Pads PDF

 

  • Lists Services Provided
  • Clinic Locations & Phone Numbers

(max 50)

The Balls in Your Court Booklet

  • Signs and Symptoms of Testicular Cancer
  • 3 Steps to a Self-Examination

(max 50)

You & The Pill Booklet

  • What is the pill and methods
  • Risks and side effects

(max 50)

Substance Misuse

Women & Alcohol Resource PDF

Magazine

(max 25)

Alcohol & You PDF

Booklet

(max 25)

What is a Standard Drink PDF

Poster

(max 50)

Drinking Alcohol Increases Your Risk for Cancer PDF

Poster

(max 5)

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For more information call Durham Health Connection Line
905-666-6241 or 1-800-841-2729