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Champlain Complex Care Program

Referral Form and Criteria Information

We Accept Referrals:

We Do Not Accept Referrals:

  • Multicomplex child (see complexity criteria)
  • Medically fragile (see fragility criteria)
  • Dependency on high intensity care/technological device
  • Has an existing risk of an unexpected severe acute life-threatening event.
  • Child is under 16 at the time of referral
  • Child has a primary care provider that will remain actively involved in patient's care
  • Child has an unmet need for care coordination
  • Child is over 16 years of age at the time of referral
  • The medical condition(s) of the child fit into a pre-existing team health care providers offering coordination of care between all required service providers (example: Eating Disorders OPT, Psychology, Psychiatry, Dermatology, PT/OT, Cystic Fibrosis Rehab Med, Spina Bifida, Oncology, Down Syndrome Clinic, Neuromuscular Clinic)

To refer a patient to the program:

PDF symbolDownload Program Referral Form

Mail or fax Program Referral Form to:

Champlain Complex Care Program
Room 2011
Children’s Hospital of Eastern Ontario
401 Smyth Rd.
Ottawa, ON K1H 1L1
FAX: 613-738-4251

Return to Champlain Complex Care Program

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