Essential Care Partner (ECP) Intake Form

This intake form is for all Essential Care Partners (ECP) within Hospital Programs. It is recommended that those who self-identify as ‘vulnerable’, as per the criteria below, not provide patient care for a probably or confirmed case of COVID-19. The following form must be completed by all ECPs and will be kept on file with the Clinical Programs.

All ECPs who self-identify as vulnerable are recommended to speak to the care team before providing ECP care to patients who are COVID-19 positive. Please complete the entire form.

If you have questions, please email ecp@osmh.on.ca

ECP Intake Form

Name of Essential Care Partner
ECP Email Address
ECP Phone Number
ECP Relationship to Patient
Note: Minimum 7 day stay for ECP consideration.