Register Your Patient Here
The following forms are mandatory to complete registration. Fill out and forward to the appropriate fax numbers on the forms (HIBC and local home nursing office, including our team at 250-565-5596).
Optional Forms
- EI Compassionate Benefits Form
- Expected Death In The Home Form (PDF)
- Home Nursing Referral Form (PDF)
- Home Oxygen Program Application (PDF)
- Medical Order for Scope of Treatment (MOST) Form (PDF)
- NH Palliative Care Consult Request Form (PDF)
- No CPR Form (PDF)
- NH Adult Palliative Care Order Sets
- NH Adult Palliative Care Crisis Event Order Sets
If you require copies of the Order Sets contact Palliative.Care.Consult.Team@northernhealth.ca
Contact Us
If you have any questions, concerns, or would like to be added to our monthly distribution list, please contact our team at Palliative.Care.Consult.Team@northernhealth.ca
About Northern Health Palliative Care
Assessment Tools
- Bowel Care Record (PDF)
- Confusion Assessment Scale (PDF)
- ESAS-r Graph (PDF)
- ESAS-r Numerical Scale (PDF)
- Pain Assessment (PDF)
- Symptom Assessment Acronym (PDF)
- PAINAD Log - Pain Assessment in Advanced Dementia (PDF)
- PAINAD - Pain Assessment in Advanced Dementia Scale (PDF)
- PPS Scale (PDF)
- RASS (Richmond Agitation Sedation Scale) (PDF)
- SPICT Tool (PDF)
Designated Palliative Care Beds
Education: Hot Tips
- Jan 2020 – Fentanyl Transdermal Patch (PDF)
- Nov 2019 - Fatigue, Tips for PSW's (PDF)
- Oct 2019 - Difficult Conversations in Advanced Disease (PDF)
- Sep 2019 - Providing Psychosocial Care (PDF)
- Aug 2019 - Palliative Care Bowel Orders (PDF)
- Jul 2019 - Symptom Management Kit: Do's & Don'ts (PDF)
- Jun 2019 - Delirium, Tips for PSW's (PDF)
- May 2019 - Essential Conversations in Palliative and End-of-Life Care (PDF)
- Apr 2019 - Pain in Palliative Care Top Ten Tips, LEAP Mini Module (PDF)
- Mar 2019 - Tips on Managing Dyspnea (PDF)
- Feb 2019 - Advance Care Planning (PDF)
- Jan 2019 - Palliative Care Order Sets (PDF)
- Dec 2018 - Palliative Care Resources (PDF)
- Nov 2018 - Being Aware (PDF)
- Oct 2018 - Providing Psychosocial Care, Tips for PSWs (PDF)
- Sep 2018 - Approach to End of Life Care (PDF)
- Aug 2018 - Nausea Management (PDF)
- Jul 2018 - Dyspnea (PDF)
- Jun 2018 - Fentanyl Patch Use in Palliative Patients (PDF)
- May 2018 - Top 10 Tips For Delirium (PDF)
- Mar 2018 - Bowel & Bladder Changes (PDF)
- Feb 2018 - Reduced Appetite, Weight Loss (PDF)
- Jan 2018 - Symptom Management Guidelines (PDF)
Education: Newsletters
- Winter 2019 - Recognizing and Managing Opioid Induced Neurotoxicity (PDF)
- Fall 2019 – Focusing on Self-Care in Palliative Care (PDF)
- Summer 2019 - Preparing for a Death at Home, Clinician Considerations (PDF)
- Spring 2019 - Talking with Children About Serious Illness, Dying and Death (PDF)
- Winter 2018 - Difficult Conversations (PDF)
- Fall 2018 - Respiratory Congestion (PDF)
- Summer 2018 - End-of-Life Care and Serious Persistent Mental Illness (PDF)
- Spring 2018 - Parkinson's Disease (PDF)
- Winter 2017 - Severe Bleeding (PDF)
- Summer 2017 - Venting Gastrostomy (PDF)
- Spring 2017 - Food and Fluids in the End of Life (PDF)
Education: Webinar Videos
- Jan 2020 - Fentanyl Transdermal Patch Order Set
- Nov 2019 - Support Worker Education: Fatigue, Kathy Murray Ch. 4-1
- Oct 2019 - Communication in Palliative Care by Dr. I. Reddy
- Aug 2019 - Changes in Bowel Function, Kath Murray
- Jul 2019 - NH Symptom Management Kits Update
- Jun 2019 - Delirium for PSWs, Kath Murray Ch.4
- Jan 2019 - Palliative Care Order Sets
- Dec 2018 - Your Team and Your Toolkit
- Oct 2018 - Providing Psychosocial Care for PSWs
- Sep 2018 - Approach to End of Life Care
- Jun 2018 - Pain Medication Management in Palliative Care
- Feb 2018 - Support Worker Education: Decreased Appetite and Weight Loss
- Feb 2018 - Support Worker Education: Integrating a Palliative Approach into Caregiving
- Dec 2017 - Neurodegenerative Disorders
- Nov 2017 - Difficult Breathing for Personal Support Workers
- Aug 2017 - Tools and Communication for PSW's Kath Murray
- May 2017 - EOL Care in Advanced Kidney Disease
- Jan 2017 - Music Therapy and Palliative Care
- Sep 2016 - Final Days
- Apr 2016 - Malignant Wounds in Palliative Care
- Mar 2016 - Dehydration and Hypodermoclysis at EOL
Resources: Brochures for Health Care Providers
Resources: Brochures for Patients and Families
Resources: Northern Health
- BC Inter-professional Palliative Symptom Management Guidelines (as of Jun, 2019)
- HYDROmorphone and Morphine are not the same drug! Poster (PDF)
- MOST Announcement (PDF)
- MOST DST (PDF)
- MOST e-Learning Module (OurNH)
- NHPC Program Manual (PDF)
- NH Palliative Care Symptom Guidelines 4th Edition (Oct, 2019) (PDF)
- NH Palliative Care Opioid Equianalgesia Chart (PDF)
- NH Palliative Care Bowel Protocol (PDF)
- NH Pre-Printed Orders Frequently Asked Questions (PDF)
Resources: Other
- BC Cancer Agency
- BCCA Pain & Symptom Management
- BC Hospice Palliative Care Association
- BC Palliative Care Benefits Program
- Bereavement and Grief Services
- Canadian Hospice Palliative Care Association
- Canadian HPC Nursing Standards of Practice 2009 (PDF)
- Canadian Virtual Hospice
- Canuck Place – Pediatric Hospice Palliative Care
- Caregivers Website - Ministry of Health
- Edmonton Regional Palliative Care Program
- EI Compassionate Benefits
- FNHA End-of-Life Brochure (PDF)
- Fraser Health Authority Palliative Care Program
- Joint Protocol Expected Death
- Palliative Drugs.com
- Pediatric Palliative Care Norms of Practice (PDF)
- Prince George Hospice Society
- Promoting Excellence in End of Life Care
- Victoria Hospice
Symptom Management Kits