Resources & Forms

PLEASE FAX ALL FORMS TO REFERRAL HOSPITAL - DO NOT FAX TO CCN

Special Access Forms

 

ECG Standards

 

Educational Videos

 

Healthcare Cath and Primary PCI Forms

Cath Referral Form

 


Provincial Cath Referral Form for Adult Patients

Please note:

  • Fax completed cath-referral form to the Regional Cardiac Care Coordinator at one of the following centres:
  • Do not fax the cath-referral form to the Provincial Office but directly to one of the contacts at a cardiac centre listed above.
  • This form is for use by referring physicians only; referrals for cath cannot be made by patients or other non-physicians.
  • This form can be used for referrals to all Ontario cath centres except those in Hamilton and Ottawa. Contact these cardiac centres directly to obtain the form used by each centre.

Forms - PLEASE FAX ALL FORMS TO REFERRAL HOSPITAL - DO NOT FAX TO CCN


Healthcare Cath and Primary PCI Forms

Primary PCI is defined as use of PCI as the initial mode of reperfusion with STEMI

Please ensure all MANDATORY data collection fields have been completed.

You may complete optional data elements at the discretion of the CATH Lab Director.

 

To download a .pdf copy of the form please select the link below.


 

Heart Rhythm Forms


 

CCN Registry (WTIS-CCN) Access Policy & Form
Process to obtain access:

  1. Hospital Administrator must complete a New User Access Form and the User Access Agreement that corresponds to the system they would like access to (for example the CCN Registry or CRS). The forms can be found below and must be submitted to newusers@ccn.on.ca.
  2. The Director, Clinical Registries will review and assess the application.
  3. The Director, Clinical Registries will process application within five (5) business days.
  4. Upon notification of approval of application by CCN, the following will occur:
    1. A link to the online CCN privacy training module will be sent to the applicant which must be completed prior to accessing the CCN Application
    2. A Non Disclosure Agreement (NDA) must be signed and returned to CCN.
    3. Training on the Applications will be provided through CCN (single and/or group training sessions are held throughout the calendar year at CCN or via webinars)
  5. If application is not approved by CCN, notification and explanation will be provided.
  6. Once privacy training is complete, the NDA has been received and the account has been created , the user will be contacted by telephone with the new username and password.
  7. Once username/password is received by the applicant, the applicant should log into the CCN Application, read the license agreement and click on the agree icon.
  8. CCN reserves the right to terminate end-user access in situations of misuse and/or noncompliance with the Personal Health Information Protection Act (PHIPA).

Any further questions from users can be directed to help@ccn.on.ca.

ONLINE FORM – – ACCESS TO CCN Registry and Custom Reporting Service



Advanced Cardiac Service Hospitals Performing Minimally Invasive Procedures

 

CCN Brochures

The Cardiac Care Network of Ontario makes variety of brochures available for use by both patients and families member, as well as healthcare professionals. Please select a link below for the brochures most appropriate for your use.

The following brochures and resources are designed to meet the information awareness needs of cardiac patients and physicians when navigating the cardiac care patient process.

 

To reorder CCN brochures for your hospital please click here.

 

Data Entry Resources

Our Mission, Vision & Values

As a dynamic partnership between professional providers, institutions, community members, and government, providing.....
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Committees Support CCN

A number of committees and working groups were developed to aid CCN in its operation of issues relevant to adult cardiac procedures and their management.


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