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.
Vaccines

 

Please note: The Influenza Vaccine Order Form 2019/20 will be available on our website as of Nov 1, 2019.

Immunization of School Pupils Act

Menactra®

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

School-Based Vaccines

Patients who meet specific medical criteria including certain medical conditions and allergies may have the vaccine administered in a provider’s office. Please contact Ottawa Public Health at 613-580-6744 for more information.

Human Papillomavirus (HPV) and Hepatitis B (HB) are primarily available through the Ontario publicly funded Grade 7 School Immunization Program. If they happen to miss a clinic, students can call OPH at 613-580-6744 to book an appointment at a catch-up clinic.

  • Meningococcal Conjugate ACYW135 (Menactra®) can be ordered for Grade 7-12 students requiring the vaccine using the batch order form above.

Publicly funded vaccines for Ontario

 High risk vaccines

To order vaccine, fax the order form to 613-580-2783

 Vaccine return form

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

Publicly-funded medications to treat Sexually Transmitted Infections (STI)

Adverse Events Following Immunization Reporting Form (AEFI)

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.

Resources for Adverse Events Following Immunizations (AEFIs):

Appendix B: Provincial Case Definitions for Reportable Diseases [610 KB]

 

Adverse Event Following Immunization (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.

Resources for Adverse Events Following Immunizations (AEFIs):

Appendix B: Provincial Case Definitions for Reportable Diseases [610 KB]

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