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Rehabilitation Services Policies & Forms

Policy #TitleRationaleDateSummaryLink
CLI.6310.SG.013.SD.02Information on Swallowing Difficulty with Stroke like Symptoms For Patients and their Families ARCHIVE NOTICEJan 19, 2026
CLI.6310.SG.013.FORM.02TOR BSST Swallowing Monitoring Record ARCHIVE NOTICEJan 19, 2026
CLI.6310.SG.013.FORM.01TOR BSST The Toronto Bedside Swallowing Screening Test ARCHIVE NOTICEJan 19, 2026
CLI.6310.SG.013Toronto Bedside Swallowing Screening Test TOR-BSST ARCHIVE NOTICEJan 19, 2026
CLI.6310.SG.013.SD.04Toronto Bedside Swallowing Screening Test TOR-BSST for Acute Stroke Patients Rehabilitation Services ARCHIVE NOTICEJan 19, 2026
CLI.6310.PL.006.SD.03Toronto Bedside Swallowing Test Screening AlgorithmJan 19, 2026
CLI.6310.PL.006.SD.02Information on Swallowing Difficulty with Stroke like Symptoms For Patients and their FamiliesJan 19, 2026
CLI.6310.PL.006.FORM.01TOR BSST The Toronto Bedside Swallowing Screening TestJan 19, 2026
CLI.6310.PL.006.SD.05TOR BSST Task Sheet for Staff Development ClerkJan 19, 2026
CLI.6310.PL.006.SD.04TOR BSST Task Sheet for Speech Language PathologistJan 19, 2026
CLI.6310.PL.006.SD.06TOR BSST Task Sheet for SLP Assist Rehab AssistJan 19, 2026
CLI.6310.PL.006.SD.07TOR BSST Task Sheet for Education FacilitatorJan 19, 2026
CLI.6310.PL.006.FORM.02TOR BSST Swallowing Monitoring RecordJan 19, 2026
CLI.6310.PL.006.SD.01No Food Drink Or Medication By MouthJan 19, 2026
CLI.6310.PL.006The Toronto Bedside Swallowing Screening Test Use for Acute Stroke PatientsJan 19, 2026
CLI.6310.SG.013.SD.01No Food Drink Or Medication By Mouth ARCHIVE NOTICEJan 19, 2026
CLI.6310.SG.013.SD.03Quick Reference Guide for TOR BSST Swallowing Screeners ARCHIVE NOTICEJan 19, 2026
CLI.6310.PL.005.FORM.01Violence Prevention Plan Screening Tool and Individualized Care PlanJan 12, 2026
CLI.6310.FORM.004Inpatient Referral – Fillablemade form fillable added under the Occupational Therapy column - High falls risk as indicated by "Falls Risk Assessment and Interventions for Inpatients" toolJan 5, 2026
CLI.6310.PL.004.FORM.01Working Alone Safety Assessment Formreplaced CLI.6310.SG.015.FORM.01Nov 24, 2025
CLI.6310.PL.005Violence Prevention Plan Screening and Individualized Care PlanNov 24, 2025
CLI.6310.PL.004Working Alone Safety Assessment RehabReplaced CLI.6310.SG.015Nov 24, 2025
CLI.6310.SG.015Rehab Services Working Alone Safety Assessment | ARCHIVE NOTICENov 24, 2025
CLI.6310.SG.014.FORM.01Violence Prevention Plan Screening and Individualized Care Plan Rehab Services | ARCHIVE NOTICEReplaced with CLI.6310.PL.003.FORM.01Nov 24, 2025
CLI.6310.SG.015.FORM.01Working Alone Safety Assessment Rehab Services | ARCHIVE NOTICENov 24, 2025
CLI.6310.SG.014Rehab Services Violence Prevention Plan Screening and Individualized Care Plan | ARCHIVE NOTICEReplaced with CLI.6310.PL.003Nov 24, 2025
CLI.6310.FORM.005.FSouthern Childrens Therapy Network of Manitoba Referral Form FrenchOct 13, 2025
CLI.6310.FORM.005Southern Childrens Therapy Network of Manitoba ReferralOct 13, 2025
CLI.6310.PL.002Rehabilitation Services Referral Process for Personal Care HomesMar 3, 2025
CLI.6310.PL.002.FORM.01Rehabilitation Services PCH Referral FormMar 3, 2025
CLI.6310.PL.002.FORM.06Rehabilitation Services SLP Assessment Information ScriptMar 3, 2025
CLI.6310.PL.002.FORM.05Rehabilitation Services OT PT Assessment Information ScriptMar 3, 2025
CLI.6310.FORM.002Inpatient ReferralRehabilitation Services Inpatient Referral Form revised to include under the Occupational Therapy column - high falls risk as indicated by "Falls Risk Assessment and Interventions for Inpatients" toolJul 30, 2024
CLI.6310.SG.016Referral Prioritization for Personal Care Home Rehabilitation Services OT PT and SLPNew guideline to prioritize referrals to the PCH'sOct 27, 2023
CLI.6310.SG.005Referral Prioritization Waitlist Management for Outpatient OT PT and SLP Children and Youth Services pdfStandardize OT, PT and SLP referral prioritization and waitlist management for children and youth servicesAug 9, 2023
CLI.6310.SG.003Referral Prioritization for Audiology ServicesCLI.6310.SG.001.FORM.01 name change from Rehab Services Children and Youth Referral Form to Southern Children's Therapy Network of Manitoba Referral Form and CLI.6310.SG.003.SD.01 has name change from Children's Therapy Initiative (CTI) to Children's Therapy Network of Manitoba (CTNM)Aug 4, 2023
CLI.6310.SG.003.SD.01Childrens Therapy Network of Manitoba Priority Rating Scale AudiologyName changed from Children's Therapy Initiative (CTI) to Children's Therapy Network of Manitoba (CTNM)Aug 4, 2023
CLI.6310.SG.005.SD.01Childrens Therapy Initiative CTI Network Priority Ratings Occupational TherapyName changed from Children's Therapy Initiative (CTI) to Children's Therapy Network of Manitoba (CTNM)Aug 4, 2023
CLI.6310.SG.005.SD.02Childrens Therapy Network of Manitoba Priority Ratings PhysiotherapyName changed from Children's Therapy Initiative (CTI) to Children's Therapy Network of Manitoba (CTNM)Aug 4, 2023
CLI.6310.SG.005.SD.03Childrens Therapy Network of Manitoba Priority Ratings Speech Language PathologyName changed from Children's Therapy Initiative (CTI) to Children's Therapy Network of Manitoba (CTNM)Aug 4, 2023
CLI.6310.SG.012School Division Referral Prioritization for OT and PTName change from Rehab Services Children and Youth Referral Form to Southern Children's Therapy Network of ManitobaAug 4, 2023
CLI.6310.PL.002.FORM.02Rehabilitation Services PCH OT Wait ListJun 2, 2023
CLI.6310.PL.002.FORM.03Rehabilitation Services PCH PT Wait ListJun 2, 2023
CLI.6310.PL.002.FORM.04Rehabilitation Services PCH SLP Wait ListJun 2, 2023
CLI.6310.FORM.001Rehabilitation Services Physiotherapy Vestibular AssessmentMar 16, 2023
CLI.6310.SG.004Referral Prioritization for Outpatient Hand Therapy Occupational Therapy and PhysiotherapyNov 14, 2022
CLI.6310.SG.002Referral Prioritization for Outpatient SLP Adults ServiceNov 2, 2022
CLI.6310.PL.003.SD.01Clinical Decision Algorithm for Patients with TracheostomyOct 3, 2022
CLI.6310.PL.003Tracheostomy Patient Care and Speech Language Pathology ServicesOct 3, 2022
CLI.6310.SG.006Referral Prioritization for Adult Outpatient PhysiotherapySep 23, 2022
CLI.6310.SG.007CBR and Outpatient Occupational Therapy Prioritization Guidelines Adult ServicesJun 13, 2022
CLI.6310.PR.001.SD.01Choosing a Wheelchair for Use in a Personal Care HomeFeb 3, 2022
CLI.6310.PR.001Wheelchair Acquisition Process in Personal Care HomesFeb 3, 2022
CLI.6310.SG.007.FORM.01Community Based Rehabilitation ReferralJan 28, 2022
CLI.6310.SG.002.FORM.01Rehab Services Outpatient ReferralOct 27, 2021
CLI.6310.SG.003.SD.02Priority Rating Scale Adult AudiologyMay 3, 2021
CLI.6310.SG.008Occupational Therapy Inpatient Referral PrioritizationNov 5, 2020
CLI.6310.SG.009Physiotherapy Inpatient Referral PrioritizationNov 5, 2020
CLI.6310.FORM.003Rehab Services Integrated Progress NoteMar 22, 2019
CLI.6310.SG.010SLP Inpatient Referral Prioritization GuidelinesJul 24, 2018
CLI.6310.PL.001Hot Pack ApplicationJun 16, 2016

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