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on00502
Laboratory RequisitionLaboratory Requisition Pursuant to the Mandatory Blood Testing Act, 2006 and O. Reg. 449/07 To support implementation of the Mandatory Blood Testing Act, 2006on00462
Respondent ReportForm 3 - Respondent Report - Pursuant to the Mandatory Blood Testing Act, 2006 and O. Reg. 449/07 To support implementation of the Mandatory Blood Testing Act, 2006on00461
Applicant ReportForm 2 - Applicant Report - Pursuant to the Mandatory Blood Testing Act, 2006 and O. Reg. 449/07 To support implementation of the Mandatory Blood Testing Act, 2006on00460
Physician ReportForm 1 - Physician Report Pursuant to the Mandatory Blood Testing Act, 2006 and O. Reg. 449/07 To support implementation of the Mandatory Blood Testing Act, 2006014-4871-64
User Agreement for Pharmacies with a Licensed Injection-Trained Pharmacist Requesting Publicly Funded Influenza Vaccines for the 2024/2025 Universal Influenza Immunization Program (UIIP)User Agreement for Pharmacies Requesting Publicly Funded Influenza Vaccine in accordance with the UIIP Prequalification form for health care agencies and workplaces that are required to prequalify in order to receive influenza vaccine.014-4282-64
Prequalification Form for Organizations Requesting Publicly Funded Influenza Vaccine for the 2024/2025 Universal Influenza Immunization Program (UIIP)Prequalification form for health care agencies and workplaces that are required to prequalify in order to receive influenza vaccine.014-5109-20
Specialty Vape Store RegistrationFor retailers that primarily sell vapour products to apply for a specialty vape store registration.014-5053-20
Tobacconist RegistrationFor retailers that primarily sell specialty tobacco products to apply for a tobacconist registration.014-3233-87
Seniors Co-Payment Program ApplicationThe Seniors Co-Payment Program Application is available on the Ontario Drug Benefit Program Online Applications and Forms website: https://forms.ontariodrugbenefit.ca/. If you are not able to complete the form online, please contact the SCP at 416-503-4586 (Toronto area) or 1-888-405-0405 (outside Toronto) for a paper version of this form.014-2451-67
Application for Funding Home Oxygen TherapyTo be used for all applications for Home Oxygen Therapy funding.014-4521-84
Application for Prior Approval for Full Payment of Insured Out-of-Country (OOC) & Out-of-Province (OOP) Laboratory & Genetics TestingThe OOC/OOP PA Program eForm is designed to be completed and submitted electronically for application for prior approval for full payment of insured Out-of-Country (OOC) & Out-of-Province (OOP) laboratory and genetics testing services. English and French versions can be completed online or downloaded and saved for future use.on00314
Request for Prior Approval for Full Payment of Insured Out-of-Country (OOC) Health ServicesThis form is meant to be submitted by a practicing Ontario physician on behalf of their patients to request consideration of funding for out-of-country health services. Along with the completed application form, submissions must also include relevant medical documentation.014-4524-84
Application for Approval of Full Payment of Insured OOC Health Services - Emergency/911/CritiCall TransfersPlease be advised, effective July 15, 2024 this form will be removed from the Central Forms Repository. A new, electronic form (on00134) to request consideration of funding for out-of-country health services was implemented April 15, 2024 and is available at: https://forms.mgcs.gov.on.ca/en/dataset/on00314014-4520-84
Request for Prior Approval for Full Payment of Insured Out-of-Country Health ServicesPlease be advised, effective July 15, 2024 this form will be removed from the Central Forms Repository. A new, electronic form (on00134) to request consideration of funding for out-of-country health services was implemented April 15, 2024 and is available at: https://forms.mgcs.gov.on.ca/en/dataset/on00314on00383
English - Request for Change in VendorUsed to request a change in vendor for an approved Assistive Devices Program claimon00594
Form 18 (Substitute Decisions Act)Application to the Board for a review of a finding of incapacity to manage property under subsection 20.2(1) of the Substitute Decisions Act014-4872-88
Application for Northern Physician Retention InitiativeApplication form completed by physicians to apply to Northern Physician Retention Initiative for financial incentives.014-1429-67
Application for Funding for Insulin Syringes for SeniorsUsed by senior clients, 65 years and older, who are on daily insulin injections to apply for funding for syringes.