Clinical support provided by a team that includes a Registered Nurse, Nurse Practitioner, and Social Worker.

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Services may include:

• Comprehensive clinical management such as medication optimization, diagnostic test ordering, and inhaler-use coaching.

• Education, counselling, and coaching to support behaviour change and chronic disease management (COPD, CHF), including nutrition guidance, smoking-cessation strategies, and referrals to exercise or rehabilitation programs.

• Care coordination through personalized care plans, follow-ups, and referrals to community resources that address daily living, recreation, food, and housing needs.

• Social and system navigation support, including access to income or housing services, and drug coverage advocacy.

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As our Hub is a free service and our clinicians do not bill OHIP, your Access Bonus will not be affected if you refer your patient. If you have questions or concerns, please feel free to reach out to Dr. Rebecca Stoller at Rebecca.Stoller@nygh.on.ca.