Inpatient Referral FormThis form is used to refer a child/youth to inpatient services at CPRI. Referrals for inpatient services should be submitted through the child/youth's Single Point Access Agency.The form is used to refer a child/youth to tertiary medical consultation services at CPRI. This is a one-time developmental behavioural consultation with a CPRI paediatrician or a psychiatrist. It can also include diagnostic opinion/interdisciplinary ASD diagnostic assessment. Referrals will only be accepted from a medical specialist (e.g. paediatrician, psychiatrist, neurologist, geneticist). All CPRI recommendations are provided to the referring specialist.
Direct Bank Deposit (Electronic Funds Transfer) Enrolment / Change of Information Third Party PayeesTo support direct bank deposit enrolment and information management for third party vendor records in Social Assistance ProgramsProvides program and application instructions for the Partner Facility Renewal program.
Employment/Training Income ReportForm to be completed by ODSP recipients on a monthly basis. First section of the form requires recipients to report their changes in Employment/Training and any changes in living expenses, shelter costs, family size, income or assets.To confirm the professionals clinically supervising behavioural services in the Ontario Autism Program meet the program's qualification requirements.
Cancellation of Third Party Authorization FormThe Cancellation of Third Party Authorization form stops all third party access to a client's case. Once the third party access is cancelled, only the payor or recipient will be able to receive information about their case.Ontario Works recipients who are self-employed or operate a business must submit a Business Income and Expense Report.
Adopted Person's and Descendant of Adopted Person's Application to Request a Severe Medical SearchTo allow adopted persons, and their family members, to request a search for an adopted person's birth relative or birth relative's family member, in instances of a severe mental or physical illness
Panel Lawyer Application – New Applicant
Invoice for Completing a Disability Determination Package, Medical Review Package or Providing Additional Medical InformationFor health care practitioners to bill the Ministry for their services in completing the Disability Determination Package, Medical Review Package or providing Additional Medical Information to the Disability Adjudication Unit.For overpayment and sponsorship debtors to request and submit documents online to the Accountability and Financial Unit.
Notice of Re-FilingThe form is for requests for medically necessary items that are not in the Ministry of Community and Social Services (MCSS) Vision Care Fee Schedule. Requests may be made where exceptional medical circumstances exist. Service providers must obtain pre-authorization from MCSS before providing Exceptional Circumstances services to clients.This form is for providing consent to disclose personal information.