Forms for Health Professionals

Communicable diseases

COVID-19 (SARS-CoV-2)

Deaths for which COVID-19 is an underlying or contributing cause are reportable to local Medical Officers of Health under the Health Protection and Promotion Act.

COVID-19 (SARS-CoV-2) Fatalities Reporting Form (PDF - 234 KB). This document is currently not in an accessible format. An accessible document will be posted shortly.
COVID-19 (SARS-CoV-2) Fatalities Reporting Form (webform)

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 314 KB]

Tuberculosis

These documents are currently not in an accessible format.

Latent Tuberculosis Infection (LTBI) reporting form (bilingual, pdf - 242 KB)
How to order treatment for latent tuberculosis infection (LTBI) (bilingual, pdf - 237 KB)

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.
Submit the online physician referral form to refer a patient to the Healthy Babies Healthy Children home visiting program. Healthy Growth and Development offers a free home visiting program for families, from pregnancy until the child goes to school. Service is offered in the language of the patient. This is a voluntary program; the family must consent to the referral to Ottawa Public Health.

Immunization related forms for health professionals

Jump to:

Influenza Vaccine
COVID-19 Vaccine - NEW
Publicly funded vaccines for Ontario
High Risk Vaccines
School-Based Vaccines
Rapid Antigen Tests - NEW
AEFI Reporting Form
Vaccine Return Form
Exemption Forms
Health Care Provider COVID-19 & Influenza Immunization Tool Kit

Public Health Alerts for Health Care Professionals

an illustration of multiple types of health care professionals

Influenza vaccine information for health professionals

Procedures

Pick up

Vaccine Distribution Room hours are Monday to Friday, 8 am to 4 pm. Note: October 14 and November 11 are statutory holidays and the Vaccine Distribution Room will be closed.

Use the Influenza Vaccine Order Form 2024/2025 below from Ottawa Public Health to order vaccine (not the Ministry of Health form).
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 shipped to vaccinate high-risk patients. Additional influenza orders can be placed after October 21st. Please allow up to five business days for your order to be processed.
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.
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 or at 1221 Cyrville Road, based on your clinic/facility location.
Bring your own cooler and two ice packs per cooler.

Vaccine that is not used by your clinic/facility cannot be redistributed. To reduce vaccine wastage, please only order the quantity that you are sure to use within the next two weeks. 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.

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.

Vaccine storage and handling guidelines [ PDF 351 KB ]

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.

Opening Priorix, Priorix Tetra and Varilrix Diluent Ampoules

Order vaccines

Due to upcoming staff training and inventory, please note the changes to the hours of operations for our Vaccine Distribution Centers (Constellation and Cyrville) below. Please arrange pick-ups before these dates or when normal operations resume.

Date	Hours of Operation
June 6th, 2025	Closed 8 am-noon. Regular operations will resume at 1 pm.
June 10th, 2025	Closed 8 am-noon. Regular operations will resume at 1 pm.
June 26th, 2025	Closed all day.
June 27th, 2025	Closed all day.
July 4th, 2025	Closed all day.

Influenza vaccine

Please note our current processing time is five (5) business days. Please limit your order to a two-week supply to allow for equitable distribution to all providers

This is the average number of business days from receipt of an influenza order to the time it is packed in our fridges. This does not include the delivery time if using a courier to deliver your order.

2024-25 Influenza Vaccine Order Form:

online order form
PDF version

Influenza consent form

COVID-19 vaccine

Ottawa Public Health Covid-19 Vaccine Order Form

COVID-19 vaccine online order form

Publicly funded vaccines for Ontario

Please note our current processing time is five (5) 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. This does not include the delivery time if using a courier to deliver your order.

Publicly funded vaccines for Ontario online order form
Publicly funded vaccines for Ontario PDF order form (pdf 214 KB) - fax completed form to 613-580-2783

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.

High Risk Hepatitis A or Hepatitis B Vaccine request form [PDF 233 KB]
High Risk Haemophilus b Conjugate Vaccine request form [PDF 241 KB]
High Risk Human Papillomavirus (HPV) Vaccine request form [PDF 212 KB]
High Risk Meningococcal Vaccine request form [PDF 96 KB]

School-based vaccines

Health care providers can order the school-based vaccines for their clinic(s) using the following form:

Request form for School Based Vaccines for Hep B, HPV-9, Meningococcal-ACWY135 [PDF 148 KB] This document is currently not in an accessible format. An accessible document will be posted shortly.

It is important that healthcare providers keep a record of individuals who have been vaccinated, as well provide parent(s) and/or guardian(s) or individuals with details of the vaccination(s). Parent(s) and/or guardian(s) are responsible for updating Ottawa Public Health every time their child gets immunized.

Infant and High-Risk Children RSV Prevention Program

The 2024-2025 infant and high-risk children RSV prevention program has ended.
Please keep all remaining non-expired Beyfortus and Abrysvo product inventory refrigerated in your office under appropriate cold chain for use next season.

Rapid Antigen Tests

Local health care partners and community agencies who provide health care services to Ottawa residents can use this link to find if they are eligible to access free rapid antigen tests: Provincial Antigen Screening Program | COVID-19 (coronavirus) in Ontario.

For more information on rapid antigen tests, the following resource is available:

Rapid testing for at-home use

Reporting forms

Adverse events following immunization (AEFI) reporting form

This AEFI Reporting Form should only be submitted by a healthcare provider. If you believe you have experienced, or are currently experiencing, unexpected symptoms after receiving your vaccine, please speak to your family doctor or other primary healthcare provider. If you have any questions, phone 613-580-6744 for more information.

If this is an emergency, please call 9-1-1.

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

Adverse Events Following Immunization reporting form [PDF 1.94 MB]

Submit the filled form:

Upload online

If you are unable to use the online submission option, you may fax to Ottawa Public Health at 613-580-9660

Resources for AEFIs

AEFI reporting factsheet for healthcare providers [PDF 176 KB]
Definitions and Management of Adverse Events Following Immunization: Appendix B: Provincial Case Definitions for Reportable Diseases [610 KB]

Vaccine return form

Exemption forms

Immunization of School Pupils Act

Statement of Medical Exemption – COVID-19 Vaccine

Medical exemptions are no longer required to be recorded in an individual’s COVaxON record. If an individual’s personal circumstances (e.g., health conditions, travel, employment requirements, participation in a clinical trial) warrants the need for medical documentation indicating vaccination exemption, the individual should follow-up with their healthcare provider, occupational health department or clinical trial principal investigator to request the necessary documentation.

Receive Email Updates...

Ottawa Public Health
100 Constellation Drive,
Ottawa, ON K2G 6J8

T 613-580-6744
YYT 613-580-9656
Toll free 1-866-426-8885
F 613-580-9660
Email: Email Ottawa Public Health

Forms for Health Professionals

How Do I...?

Reporting something to Ottawa Public Health or returning a message

8-1-1 Health

2-1-1 Ontario

3-1-1 City of Ottawa