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About
HOHC OHT
Strategic Plan
Partners
Contact
Services & Resources
Care Days
Access Primary Care
Where to Go for Care
Community Supports for Seniors
Community and Mental Health Support Services
Community Crisis Integrated Team (CCIT)
Dufferin-Caledon Drug Strategy Committee
Cancer Screening ↗
Palliative Care Services
Bereavement Services
Patients & Community
Caregivers in the Hills
Community Wellness Council
Patient Declaration of Values
News & Media
Lived Experiences
Videos
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Caregivers in the hills
Home
About
HOHC OHT
Strategic Plan
Partners
Contact
Services & Resources
Care Days
Access Primary Care
Where to Go for Care
Community Supports for Seniors
Community and Mental Health Support Services
Community Crisis Integrated Team (CCIT)
Dufferin-Caledon Drug Strategy Committee
Cancer Screening ↗
Palliative Care Services
Bereavement Services
Patients & Community
Caregivers in the Hills
Community Wellness Council
Patient Declaration of Values
News & Media
Lived Experiences
Videos
Home
About
HOHC OHT
Strategic Plan
Partners
Contact
Services & Resources
Care Days
Access Primary Care
Where to Go for Care
Community Supports for Seniors
Community and Mental Health Support Services
Community Crisis Integrated Team (CCIT)
Dufferin-Caledon Drug Strategy Committee
Cancer Screening ↗
Palliative Care Services
Bereavement Services
Patients & Community
Caregivers in the Hills
Community Wellness Council
Patient Declaration of Values
News & Media
Lived Experiences
Videos
HOHC OHT Primary Care Network Membership Form
About the HOHC OHT Primary Care Network (PCN)
The PCN will connect, integrate and support primary care providers within the HOHC OHT to improve the delivery and coordination of care for patients and improve primary care provider experience. The PCN will provide collaborative advice and leadership for the planning and implementation of coordinated health care in the region.
Your Name
(Required)
First
Last
CPSO/CNO #
If applicable
What is your role?
(Required)
Family Physician
Nurse Practitioner
Physician Assistant
Other
What is your practice model?
(Required)
Family Health Organization (FHO)
Family Health Group (FHG)
Fee for Service (FFS)
Family Health Team (FHT)
Community Health Centre (CHC)
Comprehensive Care Model (CCM)
Nurse Practitioner Led Clinic (NPLC)
Other
Clinic Name
(Required)
Clinic Location
(Required)
Town of Caledon
Town of Orangeville
Town of Shelburne
Town of Grand Valley
Town of Mono
Township of Amaranth
Township of East Garafraxa
Township of Melancthon
Township of Mulmur
Other
Is your clinic currently accepting new patients?
(Required)
Yes
No
Other
How are you interested in participating in the PCN? Select all that apply
Support with Patient Recruitment
PCN or OHT Working Groups/Projects
Digital Tools to Support Administrative Work
System Planning
Select All
The PCN offers a range of ways for members to engage—ranging from staying informed to participating in compensated leadership or project-based opportunities. Your selection helps us match opportunities to your interests and capacity.
Which EMR do you use? If not listed, please specify.
Telus PS Suite
OSCAR
Accuro
CHR by Telus
No EMR
Other
Do you currently use any of the below? Select all that apply
i4C (OMD)
Online Appointment Booking (OAB)
Hypercare
Ocean e-Referral
Digital Health Repository
HRM
OLIS
e-consult
How Can We Reach You?
How do you prefer we get in touch with you?
Preferred Method of Contact
Email
Phone
Your Email Address
(Required)
Email Address
Confirm Email Address
Phone Number
(Required)
The information shared on this field will be for PCN use only and will not be shared with other groups.
How can we help you?
How can we make your job easier and your patients' lives better? Let us know here.
Your Comments
By typing your name below, you agree to become a member of the Hills of Headwaters Collaborative OHT Primary Care Network. Signing this form does not create any legally binding obligations
(Required)
