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014-7179-84
Summary of Inpatient Expensesform sent to other provinces for reimbursement of inpatient claims paid (reciprocal)on00326
Emergency Admission to Secure Treatment ProgramThis form is completed by the person in charge of the secure treatment program once the criteria are met for the child's emergency admission to a secure treatment program.014-7158-84
In-Patient Standard Ward Costsform used for inpatients to Ontario hospitals who are here visiting from other provinces014-4896-64
Notice of Transfer from a School - Immunization of School Pupils ActNotice of Transfer from a School - Immunization of School Pupils Act014-4500-69
Determination of Available Monthly Income Form 4Used for the determination of applicant's available monthly income.014-5126-20
Ontario Seniors Dental Care Program Application Through GuarantorYou may use this application form to apply for the Ontario Seniors Dental Care Program if you do not have a valid Social Insurance Number (SIN) and/or if you have not filed your Personal Tax Return(s) with Canada Revenue Agency (CRA) for the most recent tax year. If you have a spouse (married or common law partner) who would also like to apply for the Program, they must complete their own application form.014-3324e-53
Appointment of Radiation Protection Officer014-5069-87
Drug Benefit Claim Reversal FormUsed by pharmacies for submitting claims or reversals014-5055-67
Authorizer Registration Change RequestTo maintain registration of health care professionals, termed authorizers, by the Assistive Devices Program014-3057-87
Nutrition ProductsUsed for obtaining authorization for nutrition products as an ODB benefit under certai circumstances014-6428-41
Form 2 - Order for Examination under Section 16014-4871-64
User Agreement for Pharmacies with a Registered Injection-Trained Pharmacist Requesting Publicly Funded Influenza Vaccines for the 2025/2026 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.014-5033-64
Healthy Smiles Ontario Emergency and Essential Services Stream (HSO-EESS) Application FormThis form is to be used by fee-for-service dental providers to enroll clients into the Emergency and Essential Services Stream of Healthy Smiles Ontario.014-4594-84
Fact Sheet - Gift of Life Consent Form - Organ and Tissue Donor Registrationaccompanied with form completed by clients to record their wishes for organ/tissue donationon00704
2025 Physician Assistant (PA) Career Start - Contact, Recruitment and Financial (CRF) FormThe form collects contact, recruitment and financial information from applicants who have successfully recruited PA graduates.on00347
Request for Disclosure of Personal Claims History (PCH) Information to a Third Party (for High-Volume Submitters)The eForm is currently unavailable at this time. We would like to have the option to re-activate the eForm at a later date.014-4928-87
Updating Private Insurance for Trillium Drug ProgramThis form 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 TDP at 416-642-3038 (Toronto area) or 1-800-575-5386 (outside Toronto) for a paper version of this form.
