Forms for Health Professionals

Communicable diseases

Reporting a communicable disease

COVID-19 (SARS-CoV-2)

Deaths for which COVID-19 is an underlying or contributing cause and the COVID-19 complication Multisystem Inflammatory Syndrome in Children (MIS-C) are reportable to local Medical Officers of Health under the Health Protection and Promotion Act.

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.
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

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 seven 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 two 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.

 

Opening Priorix, Priorix Tetra and Varilrix Diluent Ampoules

Order vaccines

Influenza vaccine

Please note our current processing time is five 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.

Ottawa Public Health Influenza Vaccine Order Form 2021-2022

Influenza consent forms

Publicly funded vaccines for Ontario

Please note our current processing time is three to five 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.

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

As an exception, for the 2020-2021 school year, healthcare providers are able to offer school-based vaccines to their patients in the community.  

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

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. 

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.)

Submit the filled form:

Upload online

OR

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

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
Immunization of School Pupils Act
 Statement of Medical Exemption – COVID-19 Vaccine

Only physician/specialists and nurse practitioners can submit medical exemptions for the COVID-19 vaccine.

The Ministry of Health has provided guidance around what conditions and contraindications qualify for a medical exemption.

Please review this document: Medical Exemption Guidance (gov.on.ca)

As per provincial guidance, in many instances, safe administration of subsequent doses of COVID-19 vaccine is possible under the management of an appropriate physician or nurse practitioner. True medical exemptions are expected to be infrequent and should be supported by expert consultation.

Referral and specialist consultation support for physicians and nurse practitioners is available through Ontario’s eConsult Service, OTN Hub, and the Special Immunization Clinic (SIC) Network.

Download and complete

Once completed submit your form online or fax to: 613-580-9660

Upload your completed COVID-19 Statement of Medical Exemption
COVID-19 related vaccine order form for pharmacies

Please use this form to request the vaccines once the approval has been granted by OPH. Please complete this form at least 48 hours before your vaccination clinic date.

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