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Services

Healthy Babies Healthy Children Referral Forms

What is the Healthy Babies Healthy Children (HBHC) Program?

The Healthy Babies Healthy Children (HBHC) program provides free home visiting services during the prenatal period and to families with children from birth up to their transition to school, to help newborns and young children get a healthy start in life. It is a confidential and voluntary home visiting program for families who may benefit from additional support during pregnancy, or any time up until their child(ren) begin school.

Referral to the program does not guarantee service – a Public Health Nurse will speak with each client to assess eligibility.

The Simcoe Muskoka District Health Unit Healthy Babies Healthy Children Program is available for those who qualify and live within the Simcoe Muskoka District Service Area.

“In accordance with Ontario’s French Language Services Act (FLSA), clients have the right to access services in French. Translation and interpretation supports are available through the HBHC program to facilitate access to French-language services. Please indicate your desire to receive services in French on the referral form below.”

Please Note: required fields are marked with an * Asterisk.

Section 1: Healthy Babies Healthy Children Referral

Definitions:
Self-Referral: Referral from a person requesting service from the HBHC Program.
Health Care Provider or Social Services Provider Referral: Referral from a health care or social services provider requesting service from the HBHC program for an individual or family.

The Simcoe Muskoka District Health Unit Healthy Babies Healthy Children Program is available to eligible families who live within Simcoe County or the District of Muskoka.

* Please select one of the following options to identify whether this is a self-referral or a referral from a health care or social services provider

* Consents

Please Note: if client does not consent to the above, the form can not be submitted and follow up from the Healthy Babies Healthy Children Program will not be completed.

YYYY/MM/DD
* Referred by (Provider)







Example: 705-721-7520
Example: 705-721-7520

Section 2: Parent/Caregiver Family Information

Example: 705-721-7520
* Is the Parent/Caregiver currently pregnant?

YYYY/MM/DD

List child under school age.

YYYY/MM/DD
* Interpretation services required?

Section 3: Reason for Referral

* Reason for Referral (please check all that apply):











* Client is looking for support with (please check all that apply):











* I am looking for support with (please check all that apply):












* Where did you learn about the HBHC Program?















 

Privacy statement: The Personal Health Information on this Healthy Babies Health Children (HBHC) Online Referral Form is collected under the authority of the Health Protection and Promotion Act applicable privacy legislation. All information collected will be stored in a confidential and secure electronic database. This information will be used for delivery of public health programs and services and to assess the need for prenatal, postpartum, or early childhood support and may be used for evaluation or statistical/research purposes. Any questions about the collection of this information should be directed to our Privacy Officer and should be forwarded to [email protected]. Additional information about SMDHU’s privacy policy can be found at Privacy Policy.

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