Hospital Patient/Essential Care Partner Screening Form Please complete this form prior to proceeding to screening on the day of your appointment.

Your care is important to us. We strive to deliver care that is centred on patients and families. This means our physicians, staff and volunteers will partner with you to create a welcoming, caring, and safe environment built on dignity and respect. Our goal is to deliver optimal care for every patient, every time. Patient and Family Centred Care (PFCC) is the provision of care that is respectful of, and responsive to individual patient/family preferences, needs, and values and ensures that those values guide all decisions. Creating a caring environment for patients and families ensures continuity of care and fosters a learning environment. PFCC is a partnership involving patients, families and health care providers that results in safe quality care. Your illness, treatment, expected outcome, and future health will be discussed with you whenever possible, by the appropriate health care provider. We will tell you our name, occupation and our role in your care. Information is clear, complete, timely, accurate and useful in helping patients and families effectively participate in care and decision-making. All patient rooms have patient bedside communication whiteboards that you, your family and your healthcare team can use to communicate information, goals and readiness for discharge.
You, or a family member, can assist us by:
  • Asking questions if you are unsure of your plan of care, treatment, diagnosis, or the role of a healthcare team member, to develop mutually agreeable care expectations.
  • Offering information on your cultural beliefs, preferences, and religious background as it relates to your care.
  • Providing or requesting an interpreter or assistance in communication when necessary.
  • Asking questions or letting us know if there is anything that you don’t understand.
  • Providing accurate and complete information about your present condition, past illnesses, hospitalizations, medications, and allergies.
  • Updating the whiteboard as needed.
  • Reporting any unexpected changes in you or your family members’ condition or symptoms to your doctor, nurse or other health care provider.
  • Forwarding your concerns or suggestions for improvement to a staff member or Manager.
One positive outcome of Patient and Family Centred Care is the development of the Patient Family Advisor (PFA) role. A PFA is a patient or care partner that has experienced care at the Hospital and is willing to share insights, ideas and experiences in ways that others can learn from. PFAs are interested in improving care experiences for others - they make a difference! Learn more about the role at How to Become a Patient or Family Advisor.