CENTRAL ZONE IPPL INTAKE FORM
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Hants & Tri-Facilities
Braeside Home for Special Care
Eastern Shore Memorial Hospital
Emergency Department
Harbourview Lodge
Musquodoboit Valley Memorial Hospital
PACU/Pre-op
Operating Room
Twin Oaks Memorial Hospital
Unit 200
Unit 500
Anesthesia
Haliburton
Diagnostic Imaging
Laboratory
Pharmacy
Respiratory Therapy
Physiotherapy Team
Social Work Team
Occupational Therapy Team
Other
Cobequid
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Emergency Department
Ambulatory Care
Other
DGH
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Critical Care
Anesthesia
Emergency Department
Endoscopy
OPD
3 East Med/Surg
3 West Med/Surg
4 East Medicine
4 West Medicine/Cardiology
5 East Medicine
5 West Medicine
Nursing Resource Team
Overflow
Operating Room
PACU, preadmission + Same Day Surgery
Diagnostic Imaging
Laboratory
Pharmacy
Respiratory Therapy
Physiotherapy Team
Social Work Team
Occupational Therapy Team
Other
HI
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Emergency Department
Anesthesia
Ambulatory Care
Operating Rooms
PACU
Pre-Op
Minor Procedures
3IMCU
4.1 Vascular & General Surgery
4.2 Plastic Surgery
5.1 CVICU
5.2 Critical Care
6.1 IMCU
6.1 Cardiac Day Unit & Cardiac Cath Lab
6.2 Cardiology
6.4 Coronary Care
7.1 Cardiac Surgery
7.2 Orthopedics
7.3 Neurosurgery
7.4 Neurology
8.1 Ortho Chronic
8.2 General Medicine/MTU
8.3 Ortho Short Stay
8.4 Medicine
Diagnostic Imaging
Laboratory
Pharmacy
Respiratory Therapy
Physiotherapy Team
Social Work Team
Occupational Therapy Team
Other
Nova Scotia Hospital
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Transition Hall
Withdraw Management Unit
Geriatric Psychiatry Acute Inpatient Unit
Short Stay Unit
Mount Hope Acute Care
Psychosocial Rehabilitation Unit
Community Transition Program
Adult Neurodevelopment Stabilization Unit
Rehab
FACT
Correctional Health Services
Pharmacy
Physiotherapy Team
Social Work Team
Occupational Therapy Team
Other
VG
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Anesthesia
Endoscopy
3B
ENT Clinic
General Surgery Clinic
GI Clinic
Gyne-Colp Clinic
Hematology Clinic
NS Cancer Centre
NSWCC
OMF Clinic
Medical Device Reprocessing
Medical Day Unit + Apheresis
Operating Room
NSCC Brachytherapy
PACU/SDSU
Ophthalmology
Brachy Unit
Nursing Resource Team
Renal: Hemodialysis Units
Renal: Home Dialysis Units
Urology Clinic
2B Ophthalmology
3A Critical Care
4B Geriatrics
5A Radiation/Gyne
5B Urology & Ophthalmology
6A Inpatient Nephrology
6A Transplant/General
6B Thoracic Surgery Surgery/Hepatology/IMCU + MOTP
7A Palliative Care
8A Hematology/BMT
9A General Surgery
9B HMU
11 Vic Chemotherapy
Diagnostic Imaging
Laboratory
Pharmacy
Respiratory Therapy
Physiotherapy Team
Social Work Team
Occupational Therapy Team
Other
Abbie Lane
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6 Lane MHA
7 Lane MHA
Physiotherapy Team
Social Work Team
Occupational Therapy Team
Other
Rehab
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5th floor
7th floor
8th floor
Physiotherapy Team
Social Work Team
Occupational Therapy Team
Pharmacy
Laboratory
Other
VMB
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9 Lane
V3East
GDH & GAC Clinic
V3W
V4
V5
V6
Physiotherapy Team
Social Work Team
Occupational Therapy Team
Pharmacy
Other
Priority
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Low (presently minimal risk to patient care/seeking opportunities for improvement)
Medium (presently potential risk and impact to patient care)
High (foreseeable risk and impact to patient care)
Urgent (Immediate impact on patient care - please contact a PPL directly)
Please provide a brief explanation and background on your request.
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What two to three things do you hope to accomplish as a result of working with us?
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