SWORBHP Forms

Click the quick links below to navigate this page

Feedback

Surveys

Request for

Training

Cross

Certification

Communication

(Self Report)

Base Hospital

Patch Form

Paramedic

Recognition

checklist training crosscert feedback Patch Form award

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All e-forms will be submitted and processed by the Southwest Ontario Regional Base Hospital Program.If you have any questions or concerns regarding this page or completion of the forms, please contact paramedicportalontario@lhsc.on.ca.

 

Feedback Surveys

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Website Redesign Survey

As part of our mission to provide you with optimal prehospital care system we will be making changes to the SWORBHP Website to create a more user friendly environment. We want your feedback!  What changes and enhancements would you like to see?

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2017-2018 Mandatory CME Survey

Please take a moment to complete our Mandatory CME course evaluation. As a course participant, your input is essential to the process of improving the training program. Your honest and constructive comments will greatly assist us in designing future training which is relevant, educational and enjoyable.

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Request for Training Date

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Please submit the applicable form below to request a training date with a SWORBHP Pre-Hospital Care Specialist. Please ensure you provide your contact information in the form for follow-up and booking.

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Cross Certification

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SWORBHP Cross Certification Form (PDF fillable form)

SWORBHP will recognize the auxiliary directives that paramedics have obtained at their previous Base Hospital and will receive automatic certification in them if the process and requirements are met.

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Communication (Self-Report)

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SWORBHP Communication Form (e-Form)

Our online Communication Form allows you to securely send us information so that we can help you as quickly as possible.  The Prehospital Care Specialist designated to audit for your service will be notified immediately of your request.

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Base Hospital Physician Patch Form

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SWORBHP Base Hospital Physician Patch Form (printable)

Effective November 1, 2016 the Base Hospital Program introduced the new Base Hospital Physician Patch Form. This form is to be filled out by the Emergency Department Physician when having a pre-hospital patient care conversation with a Paramedic on the Ambulance phone. It records the regulated acts delegated to a paramedic and the orders given for patient treatment by the ER Physician.

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Paramedic Recognition Awards (e-Forms)

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We believe that being recognized for the excellent work you do as a paramedic is very important, not only to you but to us as well. Receiving positive feedback and being honored for your accomplishments builds self-esteem, establishes a rapport, and provides for meaningful communication.

If you have any questions or concerns regarding completion of any of the forms, please contact Julie Oliveira at julie.oliveira@lhsc.on.ca.

The Base Hospital has four Paramedic Recognition Awards:

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Medical Directors Award of Excellence (e-Form)

The Medical Directors Award of Excellence will be awarded to Paramedics who have been recognized for excellence in EMS. This award is based on nomination by peers, Service Administration, chart auditors or the SWORBHP Medical Directors. A maximum of four awards per year will be presented.

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Medical Directors Commendation Award (e-Form)

The Medical Director’s Commendation Award will be awarded to Paramedics who have been recognized for delivering exceptional care to a patient(s) in the prehospital setting. This award is based on recommendation by the Local Medical Director or the receiving hospital Emergency Physician.

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Prehospital Save Award (e-Form)

The Prehospital Save Award is awarded to paramedics who have been recognized for obtaining a field ROSC. Where the patient survived to hospital discharge.

If you have done a call that you feel meets or potentially meets the criteria to be considered for a Prehospital Save Award, please complete the following form and submit to the Base Hospital for follow-up and verification. Please do not include any personal patient information on this form.

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Prehospital Newborn Delivery Award (e-Form)

The Prehospital Newborn Delivery Award is awarded to paramedics who have assisted with a prehospital newborn delivery.

If you have done a call that meets the criteria to be considered for a Prehospital Newborn Delivery Award, please complete the following form and submit to the Base Hospital for verification. Please do not include any personal patient information on this form.

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Last Updated October 6, 2017 | © 2007, LHSC, London Ontario Canada