CMHA Short Referral Form for ED. CMHA offers various services for Mental Health and Addiction Services. They also have access to psychiatry, however the client must be assigned to a Mental Health worker who will then refer to psychiatry.

Community Psychiatry Hosted by CMHA

CMHA General Referral Form for Mental Health and Addiction Services. They also have access to psychiatry, however the client must be assigned to a Mental Health worker who will then refer to psychiatry.

This program is a consultation service that is offered in the Timiskaming area. The Seniors' Mental Health team consists of two Geriatric Psychiatrists and nurse clinicians who are committed to meet the needs of the elderly. Following an in-depth assessment, a consultation report with recommendations as well as a follow-up plan is forwarded to your family physician. Your care will continue to be coordinated by your family physician in order to maintain a high quality of life in the least restrictive environment. The referrals to the program MUST be made through your family physician or your nurse practitioner. This is not an emergency service. Client Criteria: -Seniors (65yrs or older) with complex mental health needs, or younger than 65 who have a confirmed diagnosis of Alzheimer's disease or frontotemporal dementia. -Mental Health Problems: complicated by age-related medical illness/functional needs. -Must be medically stable; not in medical crisis -Must reside in the community: living at home, supportive housing, or in a facility based environment such as long-term or chronic care.

Form 2 (Order for Examination s. 16 of the Mental Health Act) is used under the same conditions as the Form 1 but is issued by a justice of the peace. Typically, the Form 2 is used by a person’s family or friends when it is not possible for the person to be examined by a doctor. However other persons who have come into contact with the person, who they believe requires mental health care can bring forwarded a “Form 2” application. Therefore any person can appear before a justice of the peace and provide sworn information that there is a person within the jurisdiction of the justice, who meets either the Box A or Box B The General Regulation enacted under the Mental Health Act states that for the purposes of this type of order, the “information on oath” that is brought before the justice of the peace may be oral or written information, and may include documents and other materials relevant to the justice’s determination as to whether the criteria are met.

NEOFACS North Eastern Ontario Family and Children's Services External Request for Mental Health Services from Medical Professionals Referral

The Temiskaming Hospital has access to visiting psychiatry for both Adults and Youth through Central Booking for outpatients. Psychiatry typically sees the patient for assessment only. There is a waiting period of approximately 3-6months. Physicians can refer directly through dictation, and are encouraged to complete the Temiskaming Hospital Psychiatric Referral Form. Health care partners such as Social Workers/Occupational Therapist/etc.. whom the client follows clinically, can refer patients by completing the Temiskaming Hospital Psychiatric Referral Form, attaching a biopsychosocial assessment providing pertinent information to referral needs, and providing the level of priority.