Signatures Required on the “Application for REB Review” St. Joseph’s Healthcare Hamilton January, 2008 The following is a list of St. Joseph’s officials who are authorized to sign the Application for REB Review form when resources involving their respective areas are required. It is the responsibility of the applicant to ensure that all areas from which resources will be required have been consulted and have indicated agreement by signing where appropriate on the Resources Utilization Pages and the Signature Page for Chief of Department; Director, Clinical Services/V.P. and Professional Practice Leader. (Please note that this list is reviewed and updated periodically.) Area: Name of Authorized Official or Designate: 1. Health Records Rose Iannone, Manager 2. Laboratory Services Matthew McQueen, Chief, Lab Medicine 3. Medication/Drugs (Pharmacy) Carolyn Gosse, Director, or Shamim Jamal-Rajan, Research Pharmacist 4. Radiology/Diagnostic Imaging Mary Ann Breitigam, Research & Special Projects Coordinator 5. Nuclear Medicine Betty Ng, Manager 6. Radiation Safety Officer Rhonda Buchy 7. Information Technology Doug Campbell, Research System Analyst Inpatient Areas: Complex Continuing Care Moyra VandeVooren, Nurse Manager Chest Unit, Head & Neck, IV, SDU Diane Husbands, Nurse Manager Signatures required on REB applications – SJHH January, 2008 1 Urology/Gynecology Martin Ruaux, Nurse Manager CRU/CCU Darlene Kennedy, Nurse Manager GI General Surgery, Surgical Short Stay Sherry Noseworthy, Nurse Manager Musculoskeletal/Rehab Patricia Mlekuz, Nurse Manager ICU Lily Waugh, Nurse Manager 3 Nephrology & Transplant Martin Ruaux, Nurse Manager Maternal Child (Combined Care, BANA, Special Care nursery) Amanda Dean Chartrand, Nurse Manager Maternal Child (Birthing, Assessment and Triage, 2 Fontbonne) Marnie Buchanan, Nurse Manager GAU, 4 Geriatrics, Palliative Care Stephanie Pust, Nurse Manager 4 CTU, MAU Donna Johnson, Nurse Manager Psychiatry (Level 10 Tower) Barb Pizzingrilli, Nurse Manager Psychiatry (Level 9 Tower) Maryanne Mancini, Nurse Manager Psychiatry (B2, D2, C2) Mary Puntillo, OSM – Schizophrenia Services Psychiatry (Consultation-Liaison, A2) Shona McIntyre, Nurse Manager Occupational Therapy Monica Alderson, Professional Practice Leader Physiotherapy Vince DePaul, Professional Practice Leader (Acting) Psychology Randi McCabe, Chief Psychologist and Professional Practice Leader January, 2008 Signatures required on REB applications – SJHH 2 Recreational Therapy Susy Marrone, Professional Practice Leader (Acting) Respiratory Therapy Jill Randall, Professional Practice Leader Social Work Jane Loncke,Professional Practice Leader (Acting) Speech-Language Pathology Jane Loncke, Professional Practice Leader Nutrition Services Rita Accadia, Clinical Nutrition Coordinator/ David Savage, Director, Nutrition & Hospitality Services and Romeo Cercone, VP - Rehabilitation & Long Term Care Outpatient Areas: DSU/PAAU/Outpatient Dept. Glen Caswell, Nurse Manager Motility, Endoscopy Sherry Noseworthy, Nurse Manager Fracture Clinic Patricia Mlekuz, Nurse Manager Dialysis, Hemo Service, Peritoneal Dialysis, Progressive Care, Kidney Function Clinic, Apheresis Peggy Maskell, Nurse Manager Dialysis (satellite programs) and home hemodialysis Kim Fagerros, Nurse Manager COAST Terry McGurk, Nurse Manager EPT, EPAU Barb Pizzingrilli, Nurse Manager Outpatient Schizophrenia Services Mary Puntillo, OSM – Schizophrenia Services Anxiety Treatment and Research Centre Randi McCabe, Chief Psychologist Signatures required on REB applications – SJHH January, 2008 3 Mood Disorders Clinic, Women’s Health Concerns Clinic Peter Bieling, OSM – Mood Disorders Community Psychiatry Maryanne Mancini, Nurse Manager East Region Mental Health Services Judi Santone, Nurse Manager Mental Health Rehabilitation Services Mary Griffiths, OSM (Acting) OR, PAR, Surgery Centre (CAHS) Pat Kahle, Nurse Manager Transplant Clinic Martin Ruaux, Nurse Manager ER Jennifer Anderson, Nurse Manager Urgent Care - CAHS, OPD - CAHS Tammy Robinson, Nurse Manager 5 Fontbonne Clinics Donna Johnson, Nurse Manager FIRH Jill Randall, Manager Director, Clinical Services’ Review (clinical programs): Derek McNally: Chest Unit, Head & Neck, IV, Stepdown Unit Respiratory Therapy, FIRH Kidney & Urinary Program: Hemodialysis Service, Kidney Function Program, Dialysis Satellite (Stoney Creek), Progressive Care, Peritoneal Dialysis/Apheresis, 3 Nephrology, RTU, Transplant Clinic, 2 Uro/Gyne Karen Prine: PeriOperative Program: OR, PAR/ Surgery Centre (CAHS), DSU, PAAU Jackie Barrett: Maternal /Child Health Program: Birthing, Maternal Registration, Post-Partum, NICU, Pediatric Day Surgery, 2 Fontbonne OB/Gyn Clinic Musculoskeletal/Fracture Clinic GI Program: GI General Surgery, Motility, Surgical Short Stay, Endoscopy Signatures required on REB applications – SJHH January, 2008 4 Ida Porteous: 4 CTU, MAU 5 Fontbonne Clinics GAU, Geriatric Services, Palliative Care Emergency Services: ER, Urgent Care CAHS Annette Gillis: Complex Continuing Care Cardiac Care: 4 CRU/CCU Critical Care: ICU, Critical Care Response Team Rehabilitation Unit Ambulatory Clinics CAHS Outpatient Dept. (OPD) Mental Health & Addictions Program – Marilyn Dakers-Hayward: Forensic Services, H2 and G2 inpatient units Psychogeriatric Services, A1 inpatient unit and Outreach Teams (Hamilton, Brant, Halton and Niagara) Schizophrenia Services – Inpatient (D2, B2 and C2) and Ambulatory Services including CSS Mood and Anxiety Disorders – Inpatient D1, Ambulatory Programs – CMHS, Women’s Health Concerns Clinic, Anxiety Research and Treatment Centre Early Intervention in Psychosis Program and Outreach Services Acquired Brain Injury Unit Mental Health & Addictions Program - Jodi Younger (Acting): Acute Inpatient Units, SJHH - (Level 9 & 10 Juravinski Tower, A2 and acute mental health beds at CMHS, and G1) Specialized Assessment Unit – G1 Mental Health Rehabilitation Services including Assertive Community Treatment Teams Acute Ambulatory Clinics including ERMHS, CPS, COAST and 3G at MUMC Addiction Services for men and women including inpatient and ambulatory services at SJHH and HHS Psychiatry Emergency Services including EPT and COAST Consultation/Liaison Service at SJHH and HHS Signatures required on REB applications – SJHH January, 2008 5 NOTE: Where a physician is the Principal Investigator or Local Principal Investigator for the study, the Chief of the Department must sign as the last signature Chief of Department Review: Department of Medicine Hugh Fuller, Chief Department of Laboratory Medicine Matthew McQueen, Chief Department of Anaesthesia Alex Dauphin, Chief Department of Diagnostic Imaging Dan Franic, Chief (Acting) Department of Emergency Medicine Agostino Bellissimo, Chief Department of Eye Medicine & Eye Surgery James Martin, Chief Department of Family Medicine Fionnella Crombie, Chief Department of Obstetrics & Gynecology Rory McDonagh, Chief Department of Pediatrics Moyez Ladhani, Deputy Chief Department of Psychiatry Robert Zipursky, Chief Department of Surgery J.E.M. (Ted) Young, Chief Centre for Evaluation of Medicines Mitchell Levine, Director & Ian Rodger, VP Research and Academic Intensive Care Unit Roman Jaeschke, Medical Director & Hugh Fuller, Chief of Medicine Palliative Care Anne Boyle (interim), Medical Director & Hugh Fuller, Chief of Medicine Signatures required on REB applications – SJHH January, 2008 6 NOTE: Where a member of an allied health profession is the Principal Investigator or Local Principal Investigator for the study, the Professional Practice Leader must sign as the last signature Audiology Linda Holingham, Professional Practice Leader Clinical Nutrition Rita Accadia, Professional Practice Leader Laboratory Medicine Bonnie Page, Professional Practice Leader Medical Radiation Technology Jay Neadles, Professional Practice Leader Nursing Heather Hoxby, Professional Practice Leader Occupational Therapy Monica Alderson, Professional Practice Leader Pharmacy Carmine Nieuwstraten, Professional Practice Leader Physiotherapy Vince DePaul, Professional Practice Leader (Acting) Psychology Randi McCabe, Chief Psychologist and Professional Practice Leader Respiratory Therapy Jill Randall, Professional Practice Leader Social Work Jane Loncke, Professional Practice Leader (Acting) Speech-Language Pathology Jane Loncke, Professional Practice Leader Therapeutic Recreation Susy Marrone, Professional Practice Leader (Acting) Signatures required on REB applications – SJHH January, 2008 7