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Hamilton Niagara Haldane Brant (HUB) LHINAcute Care to Rehab and Complex Continuing Care (CCC) Referral______Patients Last NameFirst Name(Identify Referral Destination) Rehabilitation Program Requested:

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How to fill out hnhb-request-for-home-and-community

01

Obtain a hnhb-request-for-home-and-community form from the appropriate source.

02

Fill out all required personal information including name, address, contact information.

03

Provide detailed information about the home or community services needed.

04

Be sure to include any supporting documentation or medical records that may be required.

05

Sign and date the form before submitting it to the relevant party.

Who needs hnhb-request-for-home-and-community?

01

Individuals who require home and community services such as elderly individuals, individuals with disabilities, or those recovering from an illness or injury.

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What is hnhb-request-for-home-and-community?

hnhb-request-for-home-and-community is a form used to request home and community services for individuals in need.

Who is required to file hnhb-request-for-home-and-community?

Individuals or their authorized representative are required to file hnhb-request-for-home-and-community.

How to fill out hnhb-request-for-home-and-community?

hnhb-request-for-home-and-community can be filled out by providing personal information, medical history, and details of requested services.

What is the purpose of hnhb-request-for-home-and-community?

The purpose of hnhb-request-for-home-and-community is to assess the need for home and community services and provide appropriate care.

What information must be reported on hnhb-request-for-home-and-community?

Information such as medical conditions, required services, contact information, and healthcare provider details must be reported on hnhb-request-for-home-and-community.

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