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Inpatient (0-5 Years) Referral To Public Health Unit: Pertinent Discharge Information

INPATIENT (0-5 YEARS) REFERRAL TO PUBLIC HEALTH UNIT: PERTINENT DISCHARGE INFORMATION

DOCUMENT TYPE: FORM

Purpose

This form is used to ensure continuity of care and facilitate handover of relevant discharge information from inpatient (age 0-5 years) acute care to public health.

Site Applicability

BC Children’s Inpatient Units and BC Women’s Neonatal Program

Patient Inclusion Criteria

· Inpatients 0-5 years old (refer to Appendices for patient and health region specific criteria)

Patient Exclusion Criteria

· Newborn (Maternal Newborn Program)

· Patients greater than 5 years old

· Patients referred for Nursing Support Services

· For Emergency Department patients: continue to use the Emergency Department Consultation Request form

PLACE ID STICKER HERE

(name, PHN, MRN, Sex, DOB)

Date:

Home Address (confirmed):

Temporary Address & dates of stay (if applicable):

Patient age:

Date Admitted:

Date Discharged:

Phone:

Family/Caregiver:

Allergies:

Background

Relevant Patient and Family/Caregiver Information

Relevant Medical History

Current Medical

Neurological

Respiratory

Cardiovascular

Gastro-Intestinal (include feeding plan/support)

Genitourinary

Skin/Musculoskeletal/ophthalmology

Haematology and Lab. Results (ie. Newborn screen and bili)

Infectious Diseases



Meds (include doses/frequencies)

Immunizations

· Up to date

· Given in Hospital:

Growth - Discharge weight (head circumference/length; if relevant)

Seen in Hospital By

· Lactation Consultant for Mother

· Spiritual Care

· Speech Language Pathologist

· Ministry of Children and Families

· Indigenous Health

· Dietitian

· Hearing Screening

· Hospital Social Worker

· Occupational Therapy

· Physical Therapy

· Psychology

· Other ___________________

Referred to Community Resources

· Infant Development Program (IDP)

· Nursing Support Services

· Centre for Abilities

· Primary Care Provider (Physician, Midwife, Nurse Practitioner)

· Paediatric or other Physician/Nurse Practitioner Follow up

· Income Assistance/Food Security Programs

· Other ____________________________



Recommendations for follow up:

Scheduled Appointments:

Handover of relevant information to Public Health:

· Family/Caregiver consent obtained and aware of referral to community YES/NO

· D/C & Public Health Information reviewed with family YES/NO

· Faxed to Public Health Unit (identify specific clinic/health unit) ________________________________________

Signature(s):

Appendices

· Appendix A: T6/T7 Public Health Referral Process

· Appendix B: T8/PICU Public Health Referral Process

· Appendix C: Neonatal Program Public Health Referral Process

· Appendix D: Public Health Unit by Region

Developed By

C&W Professional Practice Leader, Nursing

Version History

DATE

DOCUMENT NUMBER and TITLE

ACTION TAKEN

02-Feb-2021

C-0506-06-60951 Inpatient (0-5 Years) Referral To Public Health Unit: Pertinent Discharge Information

Approved at: C&W Best Practice Committee

Disclaimer

This document is intended for use within BC Children’s and BC Women’s Hospitals only. Any other use or reliance is at your sole risk. The content does not constitute and is not in substitution of professional medical advice. Provincial Health Services Authority (PHSA) assumes no liability arising from use or reliance on this document. This document is protected by copyright and may only be reprinted in whole or in part with the prior written approval of PHSA.

Appendix A: T6/T7 Public Health Referral Process

T6/T7 – Public Health Referral Process

Goal: Facilitate handover of relevant discharge information to ensure continuity of care from BCCH acute care to public health

WORKFLOW

TIPS

STEP 1:

· Discharge planning nurse (or delegated clinical RN as determined by unit) identify patient ready for discharge

· Determine if eligible for Public Health Nursing (PHN) follow up (see step 2 for eligibility)

· Discuss role of public health with family/caregiver and obtain consent

· If pending d/c, keep Pediatric Referral Form on chart/standard careplan and consider completing in stages.

· Note: All clinicians who add to form must sign the form.

STEP 2:

· Discharge planning nurse (or delegated clinical RN) completes PH referral form for the following children aged 0-5 years:, Note: Fraser Health is 0-2 years

· Never been home before babies

· Failure to thrive

· Non-Accidental Injury

· Families who would benefit from PH support (ie. maternal mental health concerns, determinants of health)

· Special Considerations:

Pyloric Stenosis

Previously well -> new diagnosis of cardiac, stroke, new onset seizures, metabolic or genetic disorder, developmental regression. Consider for 6 months and under (over 6 months if family support needed)

Include relevant information important for Public Health follow-up:

· Consent for referral to PH:

Example: “I’d like to send a summary of your stay here to the public health unit so they can follow up. Is that okay?”

-Share reasons for referrals: community support, check in on feeding and development, help with breast feeding etc.

· Diagnosis (if applicable)

· Family Support:

“What supports do you have at home?”

Helps identify if caregiver is alone and who may need additional support – can emphasize need for check in with public health unit when referral is sent

· Feeding plan at discharge. Include method of feeding and any variances.

· Weight at discharge

· Primary Care Provider

· Community/medical follow-up

· Immunizations – indicate ‘up to date’ if applicable and list which ones given in hospital and date

· Supplies/equipment if applicable

· Never been home before babies:

· Above points

· Birth history: apgars, gestational age, type of delivery, birth weight, head circumference, length

· Hep B status; did the newborn receive HBV/HBIG if needed?

· Discharge weight

· Newborn Screen

· Hearing Screen completed

STEP 3:

· Confirm consent obtained from family/caregiver

· Referral form faxed to appropriate public health unit (see Appendix D)

· Confirm home address and temporary address (if applicable). Indicate how long family is staying at temp address.

Ask parents: “Where are you staying and what is the best number to reach you at?”

· Fax referral form to permanent and temporary address.

Note: d/c to Ronald McDonald House – fax to Raven Song CHC.

Easter Seals – fax to Pacific Spirit CHC.

STEP 4:

· Discharge planning nurse or delegated RN clinical track discharges on spreadsheet

· Name

· Date of discharge

· Diagnosis

· Local health unit

· Date of fax

STEP 5: Pediatric Hospital Referral form is a legal copy. Ensure form goes to health records for filing.

· Pediatric referral form can stay on unit in secure area for a length of time (if RN feels they want to have it for reference). However, form then needs to go to health records for filing.

· If Pediatric referral form is to stay on health unit in secure place, ensure plan is in place to send forms to health record on a regular basis.

ADDITIONAL:

Deaths of children (all ages): NOTE-PENDING

· Inform local PH unit of deaths

· Telephone local PH to notify of death

Appendix B: T8 & PICU Public Health Referral Process

T8 & PICU – Public Health Referral Process

Goal: Facilitate handover of relevant discharge information to ensure continuity of care from BCCH acute care to public health

WORKFLOW

TIPS

STEP 1:

1. Discharge planning nurse (or delegated clinical RN as determined by unit) identify patient ready for discharge

1. Determine if eligible for PHN follow up (see step 2 for eligibility)

1. Discuss role of public health with family/caregiver and obtain consent

1. If pending d/c, keep Pediatric Referral Form on chart and consider completing in stages.

1. Note: All clinicians who add to form must sign the form.

STEP 2:

1. Discharge planning nurse (or delegated clinical RN) completes PH referral form for the following children aged 0-5 years:

· Never been home before babies

· Failure to thrive

· Families who would benefit from PH support (ie. maternal mental health concerns, determinants of health)

Include relevant information important for Public Health follow-up:

· Consent for referral to PH


· Family Support


· Weight at discharge



· Immunizations – list which ones given in hospital and date


· Never been home before babies:

1. Above points

1. Birth history: apgars, gestational age, type of delivery, birth weight, head circumference, length

1. Hep B status; did the newborn receive HBV/HBIG if needed?

1. Discharge weight

1. Newborn Screen

1. Hearing Screen completed

STEP 3:

1. Confirm consent obtained from family/caregiver

1. Referral form faxed to appropriate public health unit (see Appendix D)






STEP 4:

1. Discharge planning nurse or delegated RN clinical track discharges on spreadsheet

· Name


· Diagnosis


· Date of fax

ADDITIONAL:

Deaths of children (all ages): NOTE-PENDING (this likely will not continue – just verifying)

1. Inform local PH unit of deaths

· Telephone local PH to notify of death

·

Appendix C: Neonatal Program - Public Health Referral Process

Mother Baby Care Unit (Rabbit)

Goal: Facilitate handover of relevant discharge information to ensure continuity of care from MBC acute care to public health

WORKFLOW

TIPS

STEP 1:

· Discharge planning nurse (or delegated clinical RN as determined by unit) identify patient ready for discharge

· If pending discharge, keep 1591 liaison form or Pediatric Hospital Discharge Summary – for Public Health and workflow on chart and consider completing in stages.

Access 1591 Liaison form from PSBC site:

http://www.perinatalservicesbc.ca/health-professionals/forms

· To determine which form to use:

· If mom/baby, remained mom/baby the entire time, will complete 1591’s at discharge (includes companion status).

· If no longer a mom/baby dyad (ie. Readmission, mom doesn’t stay – goes home or back to post-partum), use pediatric referral form.

· When mom goes to companion status (and babe stays in NICU) – complete mom’s 1591 liaison form and indicate on bottom of form that baby is not discharged with mom - write in comments, baby remains in NICU.


STEP 2:

· Discharge planning nurse (or delegated clinical RN) completes appropriate form (as indicated in step 1) for all babies being discharged home (and mother if applicable).


Complete all fields of the form & include relevant information important for Public Health follow-up:



· Discharge weight

· Newborn Screen




· Family Support






· Ensure that mom and baby’s 1591 liaison forms are separated and filed in appropriate chart (mom’s 1591 in mom’s chart/newborn 1591 in newborn chart)

Note: MBC checklist exists. Will need to be modified if using this.

See sample 1591 & Pediatric Referral form (Thea/Sheilagh to complete)

STEP 3:

· Provide relevant Public Health information & teaching pamphlets to family prior to discharge (align discharge package with antepartum/postpartum. Note that these packages are available from antepartum/post-partum).

·

· VCH “Your First Days Home” pamphlet (if VCH resident). Circle appropriate health unit

· Fraser Health “Best Beginnings, Your First days at Home with Your New Baby” (if Fraser Health resident)

· Period of Purple Crying – booklet with activation code

· Going Home with Your Baby – BCWH booklet

· Biliary Atresia Stool Card

· Vital Stats Online Birth Registration

· Other if applicable (ie. Safe Sleep, Pacific Post Partum Support Society)

STEP 4:


· Referral form faxed to appropriate public health unit (see Appendix D)






STEP 5:

· Discharge planning nurse or delegated RN clinical track discharges on spreadsheet

· Name


· Diagnosis


· Date of fax

STEP 6:

· Pediatric Hospital Referral form and 1591 Liaison forms are a legal copy of patient chart. Ensure form goes to health records for filing.

· Pediatric referral form and 1591 Liaison forms can stay on unit in secure area for a length of time (if RN feels they want to have it for reference). However, form then needs to go to health records for filing.

· If forms are to stay on health unit in secure place, ensure plan is in place to send forms to health record on a regular basis.

· Ensure that mom and baby’s 1591 liaison forms are separated and filed in appropriate chart (mom’s 1591 in mom’s chart/newborn 1591 in newborn chart)

NICU – Public Health Referral Process

Goal: Facilitate handover of relevant discharge information to ensure continuity of care from NICU acute care to public health

WORKFLOW

TIPS

STEP 1:

· Patient flow coordinator (or delegated clinical RN as determined by unit) identify patient ready for discharge

· If pending discharge, keep Pediatric Hospital Discharge Summary – for Public Health and workflow on chart and consider completing in stages.

Note: BCCH updated form to be available on Wednesday


· Access form from ePOPS (when uploaded)

· This will be a part of the admission package (to print out and put on chart)

STEP 2:

· Patient flow coordinator (or delegated clinical RN) completes Pediatric Hospital Referral Form – Public Health for all NICU babies being discharged home.


Complete all fields of Pediatric Hospital Discharge Summary – for Public Health & include relevant information important for Public Health follow-up:



· Discharge weight

· Newborn Screen




· Family Support






See sample Pediatric Referral form (Thea/Sheilagh to complete)

STEP 3:

· Provide relevant Public Health information & teaching pamphlets to family prior to discharge

· Ie. Safe Sleep

· Note that mom would have received discharge package from antepartum/postpartum or Rabbit (if applicable).

STEP 4:


· Referral form faxed to appropriate public health unit (see Appendix D) – bedside nurse, patient flow coordinator or unit clerk?






STEP 5:

· Patient Flow Coordinator or delegated RN clinical track discharges on spreadsheet

· Name


· Diagnosis


· Date of fax

STEP 6:

· Pediatric Hospital Referral form is a legal copy for patient chart. Ensure form goes to health records for filing.

· Pediatric referral form can stay on unit in secure area for a length of time (if RN feels they want to have it for reference). However, form then needs to go to health records for filing.

· If forms are to stay on health unit in secure place, ensure plan is in place to send forms to health record on a regular basis.

Appendix D: Public Health Unit by Region

Public Health Unit by Region

Vancouver Coastal Health

www.vch.ca

Birken, Brackendale, Brittania Beach, Davis Bay, D’Arcy, Egmont, Garden Bay, Garibaldi Highlands, Gibsons, Gillies Bay, Halfmoon Bay, Howe Sound, Langdale, Lund, Madeira Park, Mount Currie, North Shore, Pemberton, Pender Harbor, Port Mellon, Powell River, Roberts Creek, Savary Island, Sechelt, Selma Park, Squamish, Texada, Vananda, Vancouver, Whistler, Wilson Creek and Furry Creek

Vancouver:

To look up a Vancouver Address to determine which health unit to fax it, please review the street index guide.

Community

Address

Phone/Fax

Three Bridges - CHA 1

1028 Hornby Street

P 604-331-8903

F 604-297-9343

Robert and Lily Lee - CHA 2

1669 East Broadway

P 604-67503980

F 604-297-9344

Evergreen – CHA 3

3425 Crowley Drive

P 604-872-2511

F 604-297-9345

Pacific Spirit – CHA 4

2110 West 43 Ave

P 604-261-6366

F 604-297-9346

Ravensong – CHA 5

2450 Ontario Street

P 604-709-6400

F 604-297-9347

South – CHA 6

6405 Knight Street

P 604-321-6151

F 604-297-9348

Richmond – CHA 7

8100 Granville Ave

P 604-233-3150

F 604-297-9349

North Shore – CHA 8 (& Bowen Island)

132 West Esplanade

P 604-983-6700

F 604-297-9336

Sechelt

(NOTE: Please send all of the following to Sechelt:

Gibsons, Roberts Creek, Halfmoon Bay, Pender Harbour and Egmont)

5571 Inlet Ave

P 604-885-5164

F 604-297-9321

Squamish

1140 Hunter Place

P 604-815-8522

F 604-297-9334

Whistler

4380 Lorimer Rd. Suite 202

P 604-932-3202

F 604-297-9335

Pemberton

1403 Portage Rd. PO Box 8

P 604-894-6939

F 604-297-9335

Powell River

5000 Joyce Ave

P 604-485-3310

F 604-297-9674

Bella Coola

1025 Elcho St.

P 250-799-5311

F 250-799-5635

Fraser Health

www.fraserhealth.ca

FAX ALL to 604-918-7491

Abbotsford, Agassiz, Arrow Lakes, Boston Bar, Bridal Falls, Burnaby, Cache Creek, Chilliwack, Clearbrook, Coquitlam, Cultus Lake, Deroche, Delta, Dewdney, Glen Valley, Greendale, Harrison Hot Springs, Harrison Mills, Hope, Langley, Maple Ridge, Matsqui, Mission, Mount Lehman, New Westminster, North Bend, Pitt Meadows, Popkum, Port Moody, Rosedale, Sardis, Silver Creek, Silverdale, Surrey, Vedder Crossing, White Rock, Yale and Yarrow

Vancouver Island Health Authority

https://www.islandhealth.ca/our-locations/health-unit-locations?page=0

Includes: Campbell River, Comox, Duncan, Esquimalt, Galiano Island, Gold River, Ladysmith, Lake Cowichan, Nanaimo, Parksville/Qualicum, Port Alberni, Fort Alice, Port Hardy, Port McNeill, Saanich, Saanichton, Salt Spring, Saturna Island, Sooke, Tofino/Ucluelet, Victoria

Community

Fax Number

Campbell River

P 250-850-2110

F 250-850-2454

Comox

P 250-331-8520

F 250-331-8521

Duncan

P 250-709-3050

F 250-709-3055

Esquimalt

P 250-519-5311

F 250-519-5312

Galiano Island

P 250-539-3230

F 250-539-3238

Gold River

P 250-283-2626

F 250-283-2626

Ladysmith

P 250-755-3342

F 250-740-2689

Lake Cowichan

P 250-749-6878

F 250-709-3095

Nanaimo

P 250-755-3342

F 250-755-3369

Parksville/Qualicum

P 250-947-8242

F 250-947-8241

Port Alberni

P 250-731-1315

F 250-731-1316

Port Hardy

P 250-902-6071

F 250-902-6072

Port Alice

P 250-284-3555

F 250-284-6163

Pender Island

F 250-629-0001

Port McNeill

P 250-956-4711

F 250-956-2031

Saanich

P 250-519-5100

F 250-744-1042

Saanichton

F 250-544-2403

Salt Spring Island

P 250-538-4880

F 250-538-4708

Saturna Island (covered by Saanichton)

F 250-544-2403

Sooke

P 250-519-3487

F 250-519-5184

Tofino/Ucluelet

P 250-725-4020

F 250-725-4019

Victoria

P 250-388-2200

F 250-388-2249

Northern Healthwww.northernhealth.ca

Bella Bella, Bella Coola, Burns Lake, Chetwynd, Dawson Creek, Fort Nelson, Fort St James, Fort St John, Haida Gwaii, Hazelton, Houston, Kitimat, Masset, Mc Bride, Prince George, Prince Rupert, Queen Charlotte, Quesnel, Smithers, Stewart, Terrace, Tumbler Ridge, Williams Lake, Vanderhoof

Community

Fax Number

Bella Bella

P 250-957-2308

F 250-957-2612

Bella Coola

P 250-799-5311

F 250-799-5635

Burns Lake

P 250-692-2160/250-692-2460

F 250-692-2469

Chetwynd

P 250-788-7300

F 250-788-7247

Dawson Creek (covers Atlin & Tumbler Ridge)

P 250-719-6500

F 250-719-6513

Fort Nelson

P 250-774-7092

F 250-774-7096

Fort St James

P 250-996-2700

F 250-996-2216

Fort St John

P 250-263-6000

F 250-263-6086

Haida Gwaii (Queen Charlotte Islands)

P 250-559-4902

F 250-699-6987

Hazelton

P 250-842-4640

F 250-842-4642

Houston

P 250-845-2294

F 250-845-7884

Kitimat

P 250-632-3181

F 250-632-7081

Masset

P 250-626-4702

F 250-626-5279

McBride

P 250-569-2251 ext. 2026

F 250-569-2232

Prince George

P 250-565-7478

F 250-565-7377

Prince Rupert

P 250-622-6380

F 250-622-6391

Queen Charlotte

P 250-559-4901

F 250-559-8037

Quesnel

P 250-983-6850

F 250-983-6811

Smithers

P 250-847-6400

F 250-847-5908

Stewart

P 250-636-2221

F 250-636-2715

Terrace

P 250-631-4200

F 250-638-2264

Williams Lake

P 250-302-5000

F 250-302-5002

Valemount

P 250-566-9138

F 250-566-9756

Vanderhoof

P 250-567-6900

F 250-567-6170

Interior Healthwww.interiorhealth.ca

Armstrong, Ashcroft, Barriere, Castlegar, Chase, Clearwater, Cranbrook, Creston, Elkford, Enderby, Fernie, Grand Forks, Golden, 100 Mile House, Invermere, Kamloops, Kaslo, Kimberley, Kelowna, Keremeos, Lillooet, Lumby, Merritt, Midway, Nakusp, Penticton, Nelson, Oliver, Osoyoos, Penticton, Princeton, Revelstoke, Rutland, Salmo, Salmon Arm, Sicamous, Sparwood, Summerland, Trail, Vernon, Williams Lake, West Kelowna

Community

Fax Number

Armstrong

P 250-546-4721

F 250-546-8834

Ashcroft

P 250-453-2211

F 250-453-1926

Barriere

P 250-672-9731

F 250-672-5144

Castlegar

P 250-365-7711

F 250-304-1234

Chase

P 250-679-3312

F 250-679-5329

Clearwater

P 250-674-3141

F 250-674-2477

Cranbrook

P 250-420-2200

F 250-420-2295

Creston

P 250-428-3873

F 250-428-3880

Elkford

P 250-865-2247

F 250-865-2797

Enderby

P 250-838-2450

F 250-838-6005

Fernie

P 250-423-8288

F 250-423-8280

Grand Forks

P 250-443-3150

F 250-442-3180

Kamloops

P 250-851-7300

F 250-851-7301

Kelowna

P 250-851-7300

F 250-868-7809

Keremeos

P 250-499-3029

F 250-499-3026

Lillooet

P 250-256-4233

F 250-256-1332

Lumby

P 250-547-9741

F 250-547-9743

Merritt

P 250-378-3400

F 250-378-3287

Midway

P 250-449-2887

F 250-449-2889

Nakusp

P 250-265-3608

F 250-265-5246

Nelson

P 250-505-7200

F 250-505-7211

Oliver

P 250-498-5080

F 250-498-0351

Osoyoos

P 250-495-6433

F 250-495-5142

Penticton

P 250-770-3434

F 250-770-3410

Princeton

P 250-295-4442

F 250-295-4443

Revelstoke

P 250-814-2244

F 250-814-2243

Rutland

P 250-980-4825

F 250-765-7710

Salmo

P 250-357-0104

F 250-357-0107

Salmon Arm

P 250-833-4100

F 250-833-4117

Sicamous

P 250-836-4835

F 250-836-3166

Sparwood

P 250-425-2064

F 250-425-2313

Summerland

P 250-404-8000

F 250-404-8005

Trail

P 250-364-6226

F 250-364-6218

Vernon

P 250-549-5700

F 250-549-5711

Williams Lake

P 250-302-5000

F 250-302-5002

West Kelowna

P 250-980-5150

F 250-768-9813

YUKON – fax to Whitehorse

P 867-667-8864

F 867-393-6407

C-0506-06-60951 Published Date: 18-Feb-2021

Page 16 of 19 Review Date: 18-Feb-2024

This is a controlled document for BCCH& BCW internal use only – see Disclaimer at the end of the document. Refer to online version as the print copy may not be current.

Form1591_NBandPP

CommunityLiaisonRecord(1).pdf

psbc 1591-1 – JANUARY 2011 © perinatal services bc

British Columbia Community Liaison RecordPOSTPARTUM

1surname Given Name(s)

Hospital / place of birth

pHN# birthdate (yy/mm/dd) ☐ Interpretation Req’d: Languagepermanent Address

phone: ( ) cell phone: ( )

Temporary Address


comments:

Next of Kin Relationship

Family physician & / or Midwife Admitting physician & / or Midwife

Hospital consultant / Referral

2 BIRTH SUMMARYG T p A L (at discharge) Infant birth date: Date (yy/mm/dd) Time

Ages of other children sex of infant ☐ M ☐ F ☐ Undifferentiated

Type of birth:☐ sVD ☐ VbAcAsst vaginal: ☐ VacuumForceps: ☐ Outlet ☐ Low

☐ Mid ☐ Rotationc/s: ☐ Elective ☐ Emergent

Reason:

perineum:

☐ Intact

☐ Laceration °

☐ Episiotomy

☐ Repaired

blood group Rh

EbL: ☐ <500 mL

☐ 500 – 1000 mL

☐ >1000 mL

Allergies: ☐ NKA

☐ Yes

Intrapartum analgesia / anesthetic:☐ No ☐ Yes

specify

Antibiotics:☐ No ☐ Yes

specify

breasts: ☐ previous breastfeeding experience comments

☐ Variances / feeding concerns ☐ No ☐ Yes ☐ plan (specify)

☐ Other information – e.g. birth complications, referrals

3 MATERNAL HEALTH & WELL-BEINGEmotional health & well-being:☐ Hx Depression ☐ Depression current pregnancy

☐ Medication(s) ☐ IpV

comments

Lifestyle:Tobacco use: ☐ Non smoker ☐ Quit before preg ☐ Quit during preg ☐ current smokerAlcohol use: ☐ Non drinker ☐ Quit before preg ☐ Othersubstance use: ☐ No ☐ YesOther

Tests & Procedures, Communicable Diseases & Exposure

Rubella status: ☐ Immune ☐ Non-immune

MMR Given: ☐ No ☐ Yes Date

Rh immune globulin☐ Given: Date

Hep b☐ Neg ☐ positive

Exposure to / or other communicable disease: ☐ No ☐ Yes (specify, e.g. Hep. c)

4 ADDITIONAL INFORMATIONseen by hospital resources: ☐ Lactation consultant ☐ social Worker ☐ Other (specify) ☐ Follow-up needed (specify)

support at home (specify)

Other information:

community resources, follow-up & how to access: ☐ pHN ☐ pHcp ☐ On reserve (name) ☐ Other (specify)

Given pURpLE crying materials ☐ Yes ☐ No Has Baby’s Best Chance ☐ Yes ☐ No prenatal education accessed ☐ Yes ☐ No

5 HOSPITAL DISCHARGE ☐ To home ☐ Other (specify)

Date Time

Mother D/c with baby ☐ Yes ☐ No

comment

☐ seen by liaison nurse (if applic) Date:

Health Unit ☐ Faxed signature Discharge RN / Liaison RN / Midwife (for home birth)

WHITE – community Health YELLOW – Mother’s chartpsbc 1591-2 – JANUARY 2011 © perinatal services bc

British Columbia Community Liaison RecordNEWBORN


pHN # Hospital / place of birth

permanent Address (if different from mother)


Temporary Address (if different from mother)


comments:

parent / Guardian Relationship

Family physician & / or Midwife (if different from mother) Admitting physician & / or Midwife (if different from mother)


2 BIRTH SUMMARYbirthdate

yy/mm/dd Time

sex:

☐ M ☐ F

☐ Undifferentiated

Type of birth:

☐ sVD ☐ Forceps

☐ Vacuum ☐ c/s

Gestational age

birthweight gms

Discharge wt (if >24 h) gms

Apgar score

1 min 5 min 10 min

AbO group

Rh (if applicable)Hc L

Other information (e.g. delivery complications, congenital anomaly)

3 NEWBORN HEALTH & WELL-BEINGscreening Tests & procedures, communicable Disease & Exposure

In utero exposure

Tobacco ☐ No ☐ Yes

Alcohol ☐ No ☐ Yes

substance(s) ☐ No ☐ Yes

specify:

Group b strep exposure ☐ No ☐ Yes

If yes, prophylaxis

If no prophylaxis, reason / plan:

Hep b prophylaxis indicated ☐ No ☐ Yes

☐ HbIG given

☐ Hep b vaccine given

Date

serum bilirubin level ☐ N/A

Initial μmol / L at hrs of life

D/c μmol / L at hrs of life

Treatment / follow-up

blood spot card done

☐ Yes ☐ No

If no: ☐ Deferred

☐ Refused

Initial hearing screen ☐ Yes ☐ No

Needs follow-up☐ Yes ☐ No(by bc Early Hearing program)

Newborn exposure to second-hand smoke

☐ No ☐ Yes

Infection / risk for infection ☐ No ☐ Yes specify:

4 INFANT FEEDING (at discharge)☐ Exclusive breastmilk ☐ partial breastmilk ☐ breastmilk substitute (specify)

☐ Variances (specify) ☐ Feeding plan at d / c

5 ADDITIONAL INFORMATIONseen by other resources: ☐ social Worker ☐ McFD sW ☐ Other (specify) ☐ Follow-up needed (specify)


comments

6 HOSPITAL DISCHARGE☐ Home with mother ☐ Other (specify)

Date Time



WHITE – community Health YELLOW – Infant’s chart

psbc 1591-1 – JANUARY 2011 © perinatal services bc

British Columbia Community Liaison RecordPOSTPARTUM


Hospital / place of birth

pHN# birthdate (yy/mm/dd) ☐ Interpretation Req’d: Languagepermanent Address


Temporary Address


comments:

Next of Kin Relationship

Family physician & / or Midwife Admitting physician & / or Midwife


2 BIRTH SUMMARYG T p A L (at discharge) Infant birth date: Date (yy/mm/dd) Time

Ages of other children sex of infant ☐ M ☐ F ☐ Undifferentiated

Type of birth:☐ sVD ☐ VbAcAsst vaginal: ☐ VacuumForceps: ☐ Outlet ☐ Low

☐ Mid ☐ Rotationc/s: ☐ Elective ☐ Emergent

Reason:

perineum:

☐ Intact

☐ Laceration °

☐ Episiotomy

☐ Repaired

blood group Rh

EbL: ☐ <500 mL

☐ 500 – 1000 mL

☐ >1000 mL

Allergies: ☐ NKA

☐ Yes

Intrapartum analgesia / anesthetic:☐ No ☐ Yes

specify

Antibiotics:☐ No ☐ Yes

specify

breasts: ☐ previous breastfeeding experience comments

☐ Variances / feeding concerns ☐ No ☐ Yes ☐ plan (specify)

☐ Other information – e.g. birth complications, referrals

3 MATERNAL HEALTH & WELL-BEINGEmotional health & well-being:☐ Hx Depression ☐ Depression current pregnancy

☐ Medication(s) ☐ IpV

comments

Lifestyle:Tobacco use: ☐ Non smoker ☐ Quit before preg ☐ Quit during preg ☐ current smokerAlcohol use: ☐ Non drinker ☐ Quit before preg ☐ Othersubstance use: ☐ No ☐ YesOther

Tests & Procedures, Communicable Diseases & Exposure

Rubella status: ☐ Immune ☐ Non-immune

MMR Given: ☐ No ☐ Yes Date

Rh immune globulin☐ Given: Date

Hep b☐ Neg ☐ positive

Exposure to / or other communicable disease: ☐ No ☐ Yes (specify, e.g. Hep. c)

4 ADDITIONAL INFORMATIONseen by hospital resources: ☐ Lactation consultant ☐ social Worker ☐ Other (specify) ☐ Follow-up needed (specify)

support at home (specify)

Other information:


Given pURpLE crying materials ☐ Yes ☐ No Has Baby’s Best Chance ☐ Yes ☐ No prenatal education accessed ☐ Yes ☐ No

5 HOSPITAL DISCHARGE ☐ To home ☐ Other (specify)

Date Time

Mother D/c with baby ☐ Yes ☐ No

comment



WHITE – community Health YELLOW – Mother’s chartpsbc 1591-2 – JANUARY 2011 © perinatal services bc

British Columbia Community Liaison RecordNEWBORN


pHN # Hospital / place of birth

permanent Address (if different from mother)


Temporary Address (if different from mother)


comments:

parent / Guardian Relationship

Family physician & / or Midwife (if different from mother) Admitting physician & / or Midwife (if different from mother)


2 BIRTH SUMMARYbirthdate

yy/mm/dd Time

sex:

☐ M ☐ F

☐ Undifferentiated

Type of birth:

☐ sVD ☐ Forceps

☐ Vacuum ☐ c/s

Gestational age

birthweight gms

Discharge wt (if >24 h) gms

Apgar score

1 min 5 min 10 min

AbO group

Rh (if applicable)Hc L

Other information (e.g. delivery complications, congenital anomaly)

3 NEWBORN HEALTH & WELL-BEINGscreening Tests & procedures, communicable Disease & Exposure

In utero exposure

Tobacco ☐ No ☐ Yes

Alcohol ☐ No ☐ Yes

substance(s) ☐ No ☐ Yes

specify:

Group b strep exposure ☐ No ☐ Yes

If yes, prophylaxis

If no prophylaxis, reason / plan:

Hep b prophylaxis indicated ☐ No ☐ Yes

☐ HbIG given

☐ Hep b vaccine given

Date

serum bilirubin level ☐ N/A

Initial μmol / L at hrs of life

D/c μmol / L at hrs of life

Treatment / follow-up

blood spot card done

☐ Yes ☐ No

If no: ☐ Deferred

☐ Refused

Initial hearing screen ☐ Yes ☐ No

Needs follow-up☐ Yes ☐ No(by bc Early Hearing program)

Newborn exposure to second-hand smoke

☐ No ☐ Yes

Infection / risk for infection ☐ No ☐ Yes specify:

4 INFANT FEEDING (at discharge)☐ Exclusive breastmilk ☐ partial breastmilk ☐ breastmilk substitute (specify)

☐ Variances (specify) ☐ Feeding plan at d / c

5 ADDITIONAL INFORMATIONseen by other resources: ☐ social Worker ☐ McFD sW ☐ Other (specify) ☐ Follow-up needed (specify)


comments

6 HOSPITAL DISCHARGE☐ Home with mother ☐ Other (specify)

Date Time



WHITE – community Health YELLOW – Infant’s chart

Checklist for MBC

Unit.jpg

VCH Your First Days

Home.pdf

Your FirstDays Home

Other services offered

Child Health Clinics for:• immunizations

• growth, development, safety andnutrition information

• parenting resources

Contact your Public Health Centre as soon as possible for an appointment.

Parent and Baby Groups to:• talk with a Public Health Nurse

about your questions and concerns

• meet and share information withother new parents

• hear speakers on health topics

Other Resources Healthy Families BC (information about pregnancy, babies and toddlers)www.healthyfamiliesbc.ca

HealthLink BC www.healthlinkbc.ca

Vancouver Coastal Healthwww.vch.ca

VCH Parenting Resources http://parenting.vch.ca/

Local Public Health CentreCall if you have not been phoned within 24 hours of coming home.

North ShoreNorth Shore Community Health Center 5th floor, 132 West Esplanade604-983-6700

RichmondRichmond Public Health8100 Granville Avenue604-233-3150

VancouverEvergreen Community Health Centre 3425 Crowley Drive604-872-2511

Pacific Spirit Community Health Centre 2110 West 43rd Avenue604-261-6366

Raven Song Community Health Centre 2450 Ontario Street 604-709-6400

Robert and Lily Lee Family Community Health Centre1669 East Broadway604-675-3980

South Community Health Centre6405 Knight Street604-321-6151

Three Bridges Community Health Centre 1128 Hornby Street 604-331-8900

For more copies, go online at http://vch.eduhealth.ca or email [email protected] and quote Catalogue No. GK.500.B33

For other feedback, contact us at [email protected] © Vancouver Coastal Health, August 2016

The information in this document is intended solely for the person to whom it was given by the health care team.

www.vch.ca

Following the birth of your baby, a Public Health Nurse is available to provide support to you and your family. For immediate concerns, call:

• HealthLink BC at 8-1-1For deaf and hearing-impairedassistance (TTY), call 7-1-1.Nurses are available 24 hours a day

• Your Local Public Health Centre(phone numbers are on the back)

Call a Public Health Nurse, HealthLinkBC or your Doctor if you have:

• bleeding that changes to bright red and is very heavy even when you are resting

• clots (clumps of blood) larger than a loonie

• fever greater than 38˚C (100.4˚F) and chills

• dizziness or feel faint even when you are resting

• difficulty passing urine (peeing)

• sore nipples or breasts

• a caesarean incision that is red, painful, swollen or wet

• pain in your perineum (bottom) that is not getting better

• feelings of sadness, anxiety or fears of hurting yourself or your baby

Call a Public Health Nurse, HealthLinkBC or your Doctor if your Baby:

• has a fever of 37.5°C or more (underarm temperature)

• is not latching well at the breast

• is not sucking well from breast or bottle

• is too sleepy to feed 8 or more times a day

• has yellow skin color on the body, arms, legs, or in the whites of the eyes

When feeding your baby:• hold baby skin to skin

• breastfeed at least 8 or more times a day

• feed during the day and night

Signs your baby is getting enough milk:• there are at least 3 wet diapers

and 3 loonie sized stool (“poo”) by 3 days of age

• by day 3, your breasts are feeling fuller

• you hear swallows during each feeding

Keep a record of the feedings and diaper changes in the first few days.

Your baby should have check-ups around:

• 3–4 days of age

• 7–10 days of age

• 6 weeks of age

If you do not have a primary health care provider, talk to your Public Health Nurse.

You can also talk to a Public Health Nurse about:

• changes in your body

• feelings and emotions

• concerns about your family

• birth control and sex

• rest and sleep

• smoking and alcohol use

• crying and responding to baby

• learning about your baby’s needs

• immunizations

• growth and development

• infant safety

• safe sleeping

• feeding issues

Fraser

Health_your-first-days-at-home-with-your-new-baby.pdf

Your First Days at Home with Your New Baby Public Health Services for

New Mothers, Babies & Families

Brought to you by Public Health and Maternal Infant Child and Youth Programs.fraserhealth.ca/parenting

Local Public Health UnitsIf your call is urgent, call your doctor, midwife, 811 or 911 for immediate help.

Health Unit Weekdays Weekends/Stat Holidays

Abbotsford #104 34194 Marshall Rd 604.864.3400 604.864.3418

Agassiz 7243 Pioneer Ave 604.793.7160 1.866.320.7582

Burnaby #300 4946 Canada Way 604.918.7605 604.918.7601

Chilliwack 45470 Menholm Rd 604.702.4900 604.702.4903

604.507.5400 604.507.5462

604.952.3550 604.507.5462

604.860.7630 1.866.320.7582

604.539.2900 604.613.2872

604.476.7000 604.897.4892

Delta – North 11245 84 Ave

Delta – South #1826 4949 Canoe Pass Way

Hope 444 Park St

Langley 20389 Fraser Hwy

Maple Ridge #400 22470 Dewdney Trunk Rd

Mission 1st Floor 7298 Hurd Street 604.814.5500 604.217.1205

New Westminster #218 610 Sixth St 604.777.6740 604.527.4806

Surrey – Cloverdale #205 17700 56 Ave 604.575.5100 604.575.5101

Surrey – Guildford 10233 153 St 604.587.4750 604.587.4761

Surrey – Newton #200 7337 137 St 604.592.2000 604.592.2049

Surrey – North 10362 King George Blvd 604.587.7900 604.587.7908

Tri-Cities #200 205 Newport Dr 604.949.7200 604.949.7220

White Rock/South Surrey 15476 Vine Ave 604.542.4000 604.542.4073

BEGINNINGSBestfor a healthy future• A Public Health Program •

Catalogue # 256632 (March 2020) | spryberry.co To order: patienteduc.fraserhealth.ca

Public health nurses work closely with hospital nurses, doctors and midwives to provide the best possible care for new mothers and babies.

A public health nurse will call you 1–2 days after you get home with your new baby.

If you are being cared for by a midwife a public health nurse will not call you, however you are welcome to call the public health nurse or come to the local health unit.

The nurse will ask you about: • Your health • Your baby’s health • How feeding is going • Help at home • Your next doctor or midwife visit • Your questions or concerns

Public health nurses are available at your local health unit to:• Talk about how you are feeling • Help you with feeding your baby • Weigh and measure your baby

Nurse home visits are offered to mothers and babies with special health needs and to families who do not have access to transportation.

Call your doctor, midwife or HealthLink BC (811) right away if...

You have... • Bleeding from your vagina that is bright red and heavy even though you have rested • Blood clots that are larger than a “loonie” coin • Chills or a fever higher than 38° C • Dizziness • Pain or burning when you pee • Pain, swelling, or redness near your C-Section incision • Pain in your bottom that is not getting better • Redness or pain in the calf or your leg • Feelings of sadness or anxiety • Feelings that you might hurt yourself or your baby

Your baby... • Has a fever • Is too sleepy to feed at least 8 times a day • Has yellow-coloured skin on body, arms, legs (jaundice) • Has breathing problems

Helpful Books & Services for Parents

• Baby’s Best Chance: Parents’ Handbook of Pregnancy and Baby Care• Toddler’s First Steps: A Best Chance Guide to Parenting your 6- to 36-Month-Old Child

For your free copy go on-line at: healthyfamiliesbc.ca/parenting

See ‘Tools and Resources’ (right side menu box). Click ‘Key Resources’.

• HealthLink BC

Parents can phone HealthLink BC to talk with a nurse about non-emergency health information and advice. This service is available 24 hours a day, 7 days a week. Translation services are available.

Call 811 or go on-line at: www.healthlinkbc.ca

• Fraser Health

Go on-line at: fraserhealth.ca/parenting

Getting off to a good start with breastfeeding...• Your baby will feed at the breast at least 8 times in 24 hrs • You will hear your baby swallow at every feeding • By Day 2 – your baby will have at least 1 dirty diaper & 2 wet diapers • By Day 3 – your baby will have at least 2 dirty diapers & 3 wet diapers • Your breasts will be full before feeding and softer after feeding

Keep a record of your baby’s feedings & diaper changes for the first few days.

Public health nurses offer breastfeeding support 7 days a week for all mothers until their babies are six weeks of age. Breastfeeding support is available for mothers with older babies during regular office hours.

Call your local public health nurse if you have sore nipples or breasts, if your baby is not latching well, if you think you do not have enough milk or if you have any questions

Call your local public health nurse if you need extra support with breastfeeding or if you have questions.

Remember… to make an appointment to see your doctor or midwife when your baby is about one week old.

Public Health Unit by

Region_Jan 2020.docx

Public Health Unit by Region

Vancouver Coastal Health

www.vch.ca

Birken, Brackendale, Brittania Beach, Davis Bay, D’Arcy, Egmont, Garden Bay, Garibaldi Highlands, Gibsons, Gillies Bay, Halfmoon Bay, Howe Sound, Langdale, Lund, Madeira Park, Mount Currie, North Shore, Pemberton, Pender Harbor, Port Mellon, Powell River, Roberts Creek, Savary Island, Sechelt, Selma Park, Squamish, Texada, Vananda, Vancouver, Whistler, Wilson Creek and Furry Creek

Vancouver:

To look up a Vancouver Address to determine which health unit to fax it, please review the street index guide.

Community

Address

Phone/Fax

Three Bridges - CHA 1

1028 Hornby Street

P 604-331-8903

F 604-297-9343

Robert and Lily Lee - CHA 2

1669 East Broadway

P 604-67503980

F 604-297-9344

Evergreen – CHA 3

3425 Crowley Drive

P 604-872-2511

F 604-297-9345

Pacific Spirit – CHA 4

2110 West 43 Ave

P 604-261-6366

F 604-297-9346

Ravensong – CHA 5

2450 Ontario Street

P 604-709-6400

F 604-297-9347

South – CHA 6

6405 Knight Street

P 604-321-6151

F 604-297-9348

Richmond – CHA 7

8100 Granville Ave

P 604-233-3150

F 604-297-9349

North Shore – CHA 8 (& Bowen Island)

132 West Esplanade

P 604-983-6700

F 604-297-9336

Sechelt

(NOTE: Please send all of the following to Sechelt:

Gibsons, Roberts Creek, Halfmoon Bay, Pender Harbour and Egmont)

5571 Inlet Ave

P 604-885-5164

F 604-297-9321

Squamish

1140 Hunter Place

P 604-815-8522

F 604-297-9334

Whistler

4380 Lorimer Rd. Suite 202

P 604-932-3202

F 604-297-9335

Pemberton

1403 Portage Rd. PO Box 8

P 604-894-6939

F 604-297-9335

Powell River

5000 Joyce Ave

P 604-485-3310

F 604-297-9674

Bella Coola

1025 Elcho St.

P 250-799-5311

F 250-799-5635

Fraser Health

www.fraserhealth.ca

FAX ALL to 604-714-9418

Abbotsford, Agassiz, Arrow Lakes, Boston Bar, Bridal Falls, Burnaby, Cache Creek, Chilliwack, Clearbrook, Coquitlam, Cultus Lake, Deroche, Delta, Dewdney, Glen Valley, Greendale, Harrison Hot Springs, Harrison Mills, Hope, Langley, Maple Ridge, Matsqui, Mission, Mount Lehman, New Westminster, North Bend, Pitt Meadows, Popkum, Port Moody, Rosedale, Sardis, Silver Creek, Silverdale, Surrey, Vedder Crossing, White Rock, Yale and Yarrow

Vancouver Island Health Authority

https://www.islandhealth.ca/our-locations/health-unit-locations?page=0

Includes: Campbell River, Comox, Duncan, Esquimalt, Galiano Island, Gold River, Ladysmith, Lake Cowichan, Nanaimo, Parksville/Qualicum, Port Alberni, Fort Alice, Port Hardy, Port McNeill, Saanich, Saanichton, Salt Spring, Saturna Island, Sooke, Tofino/Ucluelet, Victoria

Community

Fax Number

Campbell River

P 250-850-2110

F 250-850-2454

Comox

P 250-331-8520

F 250-331-8521

Duncan

P 250-709-3050

F 250-709-3055

Esquimalt

P 250-519-5311

F 250-519-5312

Galiano Island

P 250-539-3230

F 250-539-3238

Gold River

P 250-283-2626

F 250-283-2626

Ladysmith

P 250-755-3342

F 250-740-2689

Lake Cowichan

P 250-749-6878

F 250-709-3095

Nanaimo

P 250-755-3342

F 250-755-3369

Parksville/Qualicum

P 250-947-8242

F 250-947-8241

Port Alberni

P 250-731-1315

F 250-731-1316

Port Hardy

P 250-902-6071

F 250-902-6072

Port Alice

P 250-284-3555

F 250-284-6163

Pender Island

F 250-629-0001

Port McNeill

P 250-956-4711

F 250-956-2031

Saanich

P 250-519-5100

F 250-744-1042

Saanichton

F 250-544-2403

Salt Spring Island

P 250-538-4880

F 250-538-4708

Saturna Island (covered by Saanichton)

F 250-544-2403

Sooke

P 250-519-3487

F 250-519-5184

Tofino/Ucluelet

P 250-725-4020

F 250-725-4019

Victoria

P 250-388-2200

F 250-388-2249

Northern Healthwww.northernhealth.ca

Bella Bella, Bella Coola, Burns Lake, Chetwynd, Dawson Creek, Fort Nelson, Fort St James, Fort St John, Haida Gwaii, Hazelton, Houston, Kitimat, Masset, Mc Bride, Prince George, Prince Rupert, Queen Charlotte, Quesnel, Smithers, Stewart, Terrace, Tumbler Ridge, Williams Lake, Vanderhoof

Community

Fax Number

Bella Bella

P 250-957-2308

F 250-957-2612

Bella Coola

P 250-799-5311

F 250-799-5635

Burns Lake

P 250-692-2160/250-692-2460

F 250-692-2469

Chetwynd

P 250-788-7300

F 250-788-7247

Dawson Creek (covers Atlin & Tumbler Ridge)

P 250-719-6500

F 250-719-6513

Fort Nelson

P 250-774-7092

F 250-774-7096

Fort St James

P 250-996-2700

F 250-996-2216

Fort St John

P 250-263-6000

F 250-263-6086

Haida Gwaii (Queen Charlotte Islands)

P 250-559-4902

F 250-699-6987

Hazelton

P 250-842-4640

F 250-842-4642

Houston

P 250-845-2294

F 250-845-7884

Kitimat

P 250-632-3181

F 250-632-7081

Masset

P 250-626-4702

F 250-626-5279

McBride

P 250-569-2251 ext. 2026

F 250-569-2232

Prince George

P 250-565-7478

F 250-565-7377

Prince Rupert

P 250-622-6380

F 250-622-6391

Queen Charlotte

P 250-559-4901

F 250-559-8037

Quesnel

P 250-983-6850

F 250-983-6811

Smithers

P 250-847-6400

F 250-847-5908

Stewart

P 250-636-2221

F 250-636-2715

Terrace

P 250-631-4200

F 250-638-2264

Williams Lake

P 250-302-5000

F 250-302-5002

Valemount

P 250-566-9138

F 250-566-9756

Vanderhoof

P 250-567-6900

F 250-567-6170

Interior Healthwww.interiorhealth.ca

Armstrong, Ashcroft, Barriere, Castlegar, Chase, Clearwater, Cranbrook, Creston, Elkford, Enderby, Fernie, Grand Forks, Golden, 100 Mile House, Invermere, Kamloops, Kaslo, Kimberley, Kelowna, Keremeos, Lillooet, Lumby, Merritt, Midway, Nakusp, Penticton, Nelson, Oliver, Osoyoos, Penticton, Princeton, Revelstoke, Rutland, Salmo, Salmon Arm, Sicamous, Sparwood, Summerland, Trail, Vernon, Williams Lake, West Kelowna

Community

Fax Number

Armstrong

P 250-546-4721

F 250-546-8834

Ashcroft

P 250-453-2211

F 250-453-1926

Barriere

P 250-672-9731

F 250-672-5144

Castlegar

P 250-365-7711

F 250-304-1234

Chase

P 250-679-3312

F 250-679-5329

Clearwater

P 250-674-3141

F 250-674-2477

Cranbrook

P 250-420-2200

F 250-420-2295

Creston

P 250-428-3873

F 250-428-3880

Elkford

P 250-865-2247

F 250-865-2797

Enderby

P 250-838-2450

F 250-838-6005

Fernie

P 250-423-8288

F 250-423-8280

Grand Forks

P 250-443-3150

F 250-442-3180

Kamloops

P 250-851-7300

F 250-851-7301

Kelowna

P 250-851-7300

F 250-868-7809

Keremeos

P 250-499-3029

F 250-499-3026

Lillooet

P 250-256-4233

F 250-256-1332

Lumby

P 250-547-9741

F 250-547-9743

Merritt

P 250-378-3400

F 250-378-3287

Midway

P 250-449-2887

F 250-449-2889

Nakusp

P 250-265-3608

F 250-265-5246

Nelson

P 250-505-7200

F 250-505-7211

Oliver

P 250-498-5080

F 250-498-0351

Osoyoos

P 250-495-6433

F 250-495-5142

Penticton

P 250-770-3434

F 250-770-3410

Princeton

P 250-295-4442

F 250-295-4443

Revelstoke

P 250-814-2244

F 250-814-2243

Rutland

P 250-980-4825

F 250-765-7710

Salmo

P 250-357-0104

F 250-357-0107

Salmon Arm

P 250-833-4100

F 250-833-4117

Sicamous

P 250-836-4835

F 250-836-3166

Sparwood

P 250-425-2064

F 250-425-2313

Summerland

P 250-404-8000

F 250-404-8005

Trail

P 250-364-6226

F 250-364-6218

Vernon

P 250-549-5700

F 250-549-5711

Williams Lake

P 250-302-5000

F 250-302-5002

West Kelowna

P 250-980-5150

F 250-768-9813

YUKON – fax to Whitehorse

P 867-667-8864

F 867-393-6407

Street Index

Vancouver Health Units.pdf

VancouverStreet From To Description CHA Neighbourhood Team Telephone

1ST AVE E 2 396 CHA5 (RAVEN SONG) WEST 709-6400

1ST AVE E 1300 2399 CHA2 (GRANDVIEW) Grandview 675-3980

1ST AVE E 2421 3689 CHA3 (EVERGREEN) Hastings/Sunrise 872-2511

1ST AVE W 2 420 CHA5 (RAVEN SONG) WEST 709-6400

1ST AVE W 1505 1755 CHA1 (THREE BRIDGES) Fairview 736-9844

1ST AVE W 1805 3699 CHA4 (PACIFIC SPIRIT) Kitsilano/Shaughnessy 261-6366

1ST AVE W 3700 4598 CHA4 (PACIFIC SPIRIT) Dunbar/Point Grey 261-6366

2ND AVE E 6 399 CHA5 (RAVEN SONG) WEST 709-6400

2ND AVE E 400 1295 CHA5 (RAVEN SONG) EAST 709-6400

2ND AVE E 1332 2390 CHA2 (GRANDVIEW) Grandview 675-3980

2ND AVE E 2405 3492 CHA3 (EVERGREEN) Hastings/Sunrise 872-2511

2ND AVE W 5 450 CHA5 (RAVEN SONG) WEST 709-6400

2ND AVE W 1500 1782 CHA1 (THREE BRIDGES) Fairview 736-9844

2ND AVE W 1822 3699 CHA4 (PACIFIC SPIRIT) Kitsilano/Shaughnessy 261-6366

2ND AVE W 3700 4786 CHA4 (PACIFIC SPIRIT) Dunbar/Point Grey 261-6366

3RD AVE E 6 250 CHA5 (RAVEN SONG) WEST 709-6400

3RD AVE E 1320 2395 CHA2 (GRANDVIEW) Grandview 675-3980

3RD AVE E 2404 3497 CHA3 (EVERGREEN) Hastings/Sunrise 872-2511

3RD AVE W 3 290 CHA5 (RAVEN SONG) WEST 709-6400

3RD AVE W 1502 1780 CHA1 (THREE BRIDGES) Fairview 736-9844

3RD AVE W 1820 3699 CHA4 (PACIFIC SPIRIT) Kitsilano/Shaughnessy 261-6366

3RD AVE W 3700 4697 CHA4 (PACIFIC SPIRIT) Dunbar/Point Grey 261-6366

4TH AVE E 11 273 CHA5 (RAVEN SONG) WEST 709-6400

4TH AVE E 400 1299 CHA5 (RAVEN SONG) EAST 709-6400

4TH AVE E 1311 2388 CHA2 (GRANDVIEW) Grandview 675-3980

4TH AVE E 2430 3636 CHA3 (EVERGREEN) Hastings/Sunrise 872-2511

4TH AVE W 5 368 CHA5 (RAVEN SONG) WEST 709-6400

4TH AVE W 1310 1793 CHA1 (THREE BRIDGES) Fairview 736-9844

4TH AVE W 1804 3699 CHA4 (PACIFIC SPIRIT) Kitsilano/Shaughnessy 261-6366

4TH AVE W 3700 4796 CHA4 (PACIFIC SPIRIT) Dunbar/Point Grey 261-6366

































9TH AVE W all CHA4 (PACIFIC SPIRIT) Dunbar/Point Grey 261-6366



10TH AVE E 1316 2884 CHA3 (EVERGREEN) Cedar Cottage 872-2511


Ref_-_Street_Index_(Van) Page 1 of 27

Street From To Description CHA Neighbourhood Team Telephone







11TH AVE E 2890 3625 CHA3 (EVERGREEN) Collingwood 872-2511

































15TH AVE W 1305 1385 odd only CHA1 (THREE BRIDGES) Fairview 736-9844

15TH AVE W 1320 1350 even only CHA4 (PACIFIC SPIRIT) Kitsilano/Shaughnessy 261-6366






16TH AVE E 803 1157 odd only CHA5 (RAVEN SONG) EAST 709-6400

16TH AVE E 808 1188 even only CHA3 (EVERGREEN) Cedar Cottage 872-2511




16TH AVE W 503 1795 odd only CHA1 (THREE BRIDGES) Fairview 736-9844

16TH AVE W 510 988 even only CHA5 (RAVEN SONG) WEST 709-6400

16TH AVE W 1006 1798 even only CHA4 (PACIFIC SPIRIT) Kitsilano/Shaughnessy 261-6366


16TH AVE W 2100 3298 even only CHA4 (PACIFIC SPIRIT) Kerrisdale/Arbutus 261-6366

16TH AVE W 2101 3699 odd only CHA4 (PACIFIC SPIRIT) Kitsilano/Shaughnessy 261-6366

16TH AVE W 3300 3698 even only CHA4 (PACIFIC SPIRIT) Dunbar/Point Grey 261-6366

16TH AVE W 3301 3699 odd only CHA4 (PACIFIC SPIRIT) Kitsilano/Shaughnessy 261-6366








17TH AVE W 2100 3199 CHA4 (PACIFIC SPIRIT) Kerrisdale/Arbutus 261-6366




























21ST AVE E 4 399 CHA5 (RAVEN SONG) WEST 709-6400

21ST AVE E 400 1156 CHA5 (RAVEN SONG) EAST 709-6400

21ST AVE E 1305 2899 CHA3 (EVERGREEN) Cedar Cottage 872-2511

21ST AVE E 2900 3291 CHA3 (EVERGREEN) Collingwood 872-2511


21ST AVE W 2115 3199 CHA4 (PACIFIC SPIRIT) Kerrisdale/Arbutus 261-6366




22ND AVE E 1429 2899 CHA3 (EVERGREEN) Cedar Cottage 872-2511

22ND AVE E 2900 3697 CHA3 (EVERGREEN) Collingwood 872-2511


22ND AVE W 2115 3099 CHA4 (PACIFIC SPIRIT) Kerrisdale/Arbutus 261-6366



23RD AVE E 400 1396 CHA5 (RAVEN SONG) EAST 709-6400

23RD AVE E 2025 2899 CHA3 (EVERGREEN) Cedar Cottage 872-2511

23RD AVE E 2900 3594 CHA3 (EVERGREEN) Collingwood 872-2511


23RD AVE W 2203 2999 CHA4 (PACIFIC SPIRIT) Kerrisdale/Arbutus 261-6366


















































31ST AVE E 10 399 5 CHA5 (RAVEN SONG) WEST 709-6400

31ST AVE E 400 2296 5 CHA5 (RAVEN SONG) EAST 709-6400







32ND AVE W 1004 1898 CHA4 (PACIFIC SPIRIT) Kitsilano/Shaughnessy 261-6366




33RD AVE E 400 2296 CHA5 (RAVEN SONG) EAST 709-6400

33RD AVE E 2308 2498 CHA3 (EVERGREEN) Cedar Cottage 872-2511


33RD AVE W 1003 1836 CHA4 (PACIFIC SPIRIT) Kitsilano/Shaughnessy 261-6366

















































41ST AVE E 5 399 odd only CHA5 (RAVEN SONG) WEST 709-6400

41ST AVE E 34 1398 even only CHA6 (SOUTH VANCOUVER) Sunset 321-6151

41ST AVE E 401 2297 odd only CHA5 (RAVEN SONG) EAST 709-6400

41ST AVE E 1400 2500 even only CHA6 (SOUTH VANCOUVER) Fraserview 321-6151

41ST AVE E 2323 2899 odd only CHA3 (EVERGREEN) Cedar Cottage 872-2511

41ST AVE E 2500 3188 even only CHA6 (SOUTH VANCOUVER) Killarney 321-6151

41ST AVE E 2901 3009 odd only CHA3 (EVERGREEN) Collingwood 872-2511

41ST AVE W 11 949 odd only CHA5 (RAVEN SONG) WEST 709-6400

41ST AVE W 18 500 even only CHA6 (SOUTH VANCOUVER) Sunset 321-6151

41ST AVE W 1055 2099 odd only CHA4 (PACIFIC SPIRIT) Kitsilano/Shaughnessy 261-6366

42nd AVE W 1000 1498 even only CHA6 (SOUTH VANCOUVER) Marpole/Oakridge 321-6151

41ST AVE W 1500 3598 even only CHA4 (PACIFIC SPIRIT) Kerrisdale/Arbutus 261-6366

41ST AVE W 2101 3299 odd only CHA4 (PACIFIC SPIRIT) Kerrisdale/Arbutus 261-6366

41ST AVE W 3600 4050 even only CHA4 (PACIFIC SPIRIT) Dunbar/Point Grey 261-6366

41ST AVE W 3329 4093 odd only CHA4 (PACIFIC SPIRIT) Dunbar/Point Grey 261-6366

42ND AVE E 0 1399 CHA6 (SOUTH VANCOUVER) Sunset 321-6151

42ND AVE E 1400 2499 CHA6 (SOUTH VANCOUVER) Fraserview 321-6151

42ND AVE E 2500 3699 CHA6 (SOUTH VANCOUVER) Killarney 321-6151

42ND AVE W 0 400 CHA6 (SOUTH VANCOUVER) Sunset 321-6151

42ND AVE W 500 1199 CHA6 (SOUTH VANCOUVER) Marpole/Oakridge 321-6151



43RD AVE E 0 1399 CHA6 (SOUTH VANCOUVER) Sunset 321-6151

43RD AVE E 1400 2499 CHA6 (SOUTH VANCOUVER) Fraserview 321-6151

43RD AVE E 2500 3699 CHA6 (SOUTH VANCOUVER) Killarney 321-6151

43RD AVE W 20 499 CHA6 (SOUTH VANCOUVER) Sunset 321-6151

43RD AVE W 500 1499 CHA6 (SOUTH VANCOUVER) Marpole/Oakridge 321-6151



44TH AVE E 0 1399 CHA6 (SOUTH VANCOUVER) Sunset 321-6151

44TH AVE E 1400 2499 CHA6 (SOUTH VANCOUVER) Fraserview 321-6151

44TH AVE E 2500 3699 CHA6 (SOUTH VANCOUVER) Killarney 321-6151

44TH AVE W 14 400 CHA6 (SOUTH VANCOUVER) Sunset 321-6151

44TH AVE W 500 899 CHA6 (SOUTH VANCOUVER) Marpole/Oakridge 321-6151













































51ST AVE E 0 1399 CHA6 (SOUTH VANCOUVER) Sunset 321-6151

51ST AVE E 1400 2499 CHA6 (SOUTH VANCOUVER) Fraserview 321-6151

51ST AVE E 2500 3699 CHA6 (SOUTH VANCOUVER) Killarney 321-6151

51ST AVE W 607 1380 CHA6 (SOUTH VANCOUVER) Marpole/Oakridge 321-6151





























56TH AVE W all CHA6 (SOUTH VANCOUVER) Marpole/Oakridge 321-6151





57TH AVE W 1506 1778 even only CHA6 (SOUTH VANCOUVER) Marpole/Oakridge 321-6151

57TH AVE W 1525 1791 odd only CHA4 (PACIFIC SPIRIT) Kerrisdale/Arbutus 261-6366




















61ST AVE E 0 1399 CHA6 (SOUTH VANCOUVER) Sunset 321-6151

61ST AVE E 1400 2399 CHA6 (SOUTH VANCOUVER) Fraserview 321-6151

61ST AVE W 11 400 CHA6 (SOUTH VANCOUVER) Sunset 321-6151

61ST AVE W 500 1700 CHA6 (SOUTH VANCOUVER) Marpole/Oakridge 321-6151





62ND AVE W 5 499 CHA6 (SOUTH VANCOUVER) Sunset 321-6151






63RD AVE W 6 499 CHA6 (SOUTH VANCOUVER) Sunset 321-6151





64TH AVE E 2600

word: inpatient (0-5 years) referral to public health unit...

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