Forms for Health Professionals

Communicable diseases

Reporting a communicable disease

Lyme disease

All cases of Lyme disease, whether clinically diagnosed or laboratory confirmed, are reportable to local public health under the Health Protection and Promotion Act. Note: This includes individuals who have been clinically diagnosed with Lyme disease in the absence of serology. Public Health is mandated to collect information on clinical signs and symptoms (such as diameter of any erythema migrans), as well as information on tick exposure.

Health Care Provider Lyme Disease Reporting Form [PDF 170 KB]

Tuberculosis
Referral forms
  • Geriatric Psychiatry Community Services of Ottawa referral form [PDF 404 KB]
    This referral form must be used when referring older adult patients to the Geriatric Psychiatry Community Services of Ottawa (GPCSO), whose mandate is community mental health outreach. Once the referral form is received, it is triaged by the clinical coordinator and reviewed by a psychiatrist.
  • Royal Ottawa Geriatric Psychiatry Program referral form [PDF 123 KB]
    This referral form should be used to refer older adult patients to the Royal Ottawa Mental Health Centre (ROMHC), which has an ambulatory care service - a hospital based service offering interdisciplinary support, consultation and treatment through its three components: the Geriatric Psychiatry Day Hospital, Out-patient Clinic and Out-patient Electroconvulsive Therapy.
Immunization related forms for health professionals

Notices

Current vaccine order processing time: 2 business days

This is the average number of business days from receipt of a regular order to the time it is packed in our fridges and ready to be picked up by practitioner or courier.

Procedures

Pick up

Vaccine Distribution Room hours are Monday to Friday, 8 am to 4 pm. NOTE: November 11 is a statutory holiday and the Vaccine Distribution Room will be closed.

  1. Use the Influenza Vaccine Order Form 2020/2021 below from Ottawa Public Health to order vaccine (not the Ministry of Health form).
  2. Place your order by completing the number of doses required on the form. Orders will be filled in the order in which they are received, with priority to high-risk groups. The first auto-shipment will contain a predetermined amount of vaccine will be shipped to vaccinate high-risk patients. Additional influenza orders can be placed after October 19th. Please allow up to 7 business days for your order to be processed.
  3. Always reserve some vaccine for persons age 65 years and older, and persons under 65 with medical conditions that put them at high risk for influenza-related complications.
  4. Your clinic/facility will be called when your order is ready. Arrange to pick up your order within 48 hours of notification at the Ottawa Public Health Vaccine Distribution Centre, on the ground floor of 100 Constellation Drive.
  5. Bring your own cooler and 2 ice packs per cooler.

Vaccine that is not used by your clinic/facility cannot be redistributed. To reduce vaccine wastage, only order the quantity that you are sure to use within the month. You can order more vaccine as needed. Return unused vaccine to the Ottawa Public Health Immunization Program once you are finished immunizing for the season using Ottawa Public Health Vaccine Return Form below. 

If you or your staff have any questions regarding this procedure, please contact the Ottawa Public Health Vaccine Distribution Centre at 613-580-6744, ext. 24225.

Storage and handling information

Exposure to light, frozen or overheated vaccines may lead to patients experiencing a reduced immune response and/or an increase in local reactions. To avoid unnecessary vaccine wastage you should:

  • Ensure refrigerator temperatures are maintained between 2° to 8° C
    • In cases of power failures, refrigerator doors being left open, frequent opening of the refrigerator doors during clinic hours, or refrigerator malfunction that compromises the cold chain, call Ottawa Public Health 613-580-6744 and ask to be directed to the Vaccine Distribution Centre. A Vaccine Program Coordinator will assess the situation and provide you with further instructions
  • Never administer or discard exposed vaccine. Leave it in the refrigerator, and mark it as having been potentially exposed. Do not use it until the Vaccine Program Coordinator has assessed the situation.
  • Ensure your office vaccine refrigerator is not overstocked, as this may cause temperatures to fluctuate or doors to become ajar
  • Defrost the freezer regularly, as excessive ice build-up can cause temperature fluctuations

Feel free to contact OPH for further information on how to maintain a safe cold chain.

Your ongoing support to maintain the vaccine cold chain will ultimately ensure that potent vaccine is administered to your patients.

Cold chain

Ottawa Public Health's Vaccine Distribution Room ensures that each facility in the city of Ottawa storing publicly funded vaccines follow appropriate storage and handling of vaccines. Ottawa Public Health staff conducts annual visits to each facility to ensure that the refrigerators are maintained at the appropriate temperature and that facility staff record these temperatures on an ongoing basis.

What is "Cold Chain" and why is it important?

Cold chain is the maintenance of vaccines at the appropriate temperature range of + 2 ºC to + 8 ºC from the time the vaccines are manufactured until they are given to a patient.

Cold chain is important because vaccines are sensitive biological substances that can lose their strength and effectiveness if they are exposed to heat and/or direct sunlight. Freezing damages most vaccines. Exposed vaccines can result in a reduced immune response and/or increased local reactions. The loss of vaccine potency cannot be reversed.

 

Order vaccines

Influenza vaccine

 

Influenza adult consent form

Influenza child consent form

Publicly funded vaccines for Ontario

Additional Information

High risk vaccines

To order vaccine for high risk patients, fax completed form to 613-580-2783. Eligibility criteria are listed on each form.

School-based vaccines

Exceptionally this year, Hepatitis B and HPV vaccines can now be ordered by healthcare providers to be given in their offices using this order form.

We are requesting healthcare providers report to OPH the names and vaccinations received for every student who has a Grade 7 School Immunization Program vaccine administered through their office.

Menactra

Order catch-up Menactra® vaccines for clients needing to meet the new Immunization of School Pupils Act requirements using this order form.

Reporting forms

Adverse events following immunization (AEFI) reporting form

AEFI Reporting Form

To report an adverse event following immunization (AEFI), complete the reporting form and fax to Ottawa Public Health at 613-580-9660 or phone 613-580-6744 for more information.

Having trouble opening the PDF form? Download and save the form directly onto your device.

Resources for AEFIs

Vaccine return form

When returning vaccines to Ottawa Public Health, please complete the form and include a copy with vaccines being returned

Exemption forms

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