62 Forms found for Ontario

Ministries: Ministry of Health

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  • 014-0406-67
    Authorizer Agreement with the Assistive Devices Program

    The Ministry of Health and Long-Term Care's Assistive Devices Program provides customer centered support and funding to Ontario residents who have long-term physical disabilities to provide access to personalized assistive devices appropriate for the individual's basic needs. To accomplish this goal the ADP must establish relationships with health professionals in order to ensure that ADP clients are assessed for cost-effective devices that best suit their needs.

  • 014-4406-87
    Request for an Unlisted Drug Product - Exceptional Access Program (EAP)

    For faster decisions, prescribers can use the SADIE online portal to submit requests to the Exceptional Access Program (EAP). Sign in through GO Secure (https://www.ebse.health.gov.on.ca) and select SADIE from the services drop-down menu. Visit the SADIE website for more information: http://www.ontario.ca/sadie. Alternatively, this form can be used for submitting requests to the EAP by fax.

  • 014-4971-67
    Vendor Agreement

    The Ministry of Health and Long-Term Care's Assistive Devices Program provides customer centered support and funding to Ontario residents who have long-term physical disabilities to provide access to personalized assistive devices appropriate for the individual's basic needs. To accomplish this goal the ADP establishes contracts with vendors in order to ensure that ADP funding for clients are in accordance with Program policies.

  • 014-3651-41
    Funding Request - Prescribed Drugs not covered by ODB Plan

  • 014-4931-87
    Annual Deductible Re-Assessment Request

    This 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.

  • 014-4929-87
    Trillium Drug Program Application Signature Request

    This 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.

  • 014-4423-87
    Notification for Change of Information for Trillium Drug Program

    This 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.

  • 014-5050-67
    Vendor Registration Application - Home Oxygen Therapy

    The Vendor Registration Application form is an interactive form that will be completed by an Ontario retailer or supplier of home oxygen therapy who is requesting registration with the Assistive Devices Program.

  • 014-3384-83
    Application for OHIP Billing Number for Health Professionals

    Physicians complete form to apply for OHIP billing number and/or specialty billing number.

  • on00161
    MOH CYMH Service Description Schedules

    The Service Description Schedule is part of the Transfer Payment Agreement between His Majesty the King in right of Ontario as represented by the Minister of Health (“the Province”) and the Transfer Payment Recipient. The Transfer Payment Recipient will deliver the programs and services in accordance with the requirements as outlined in this Service Description Schedule document in addition to all conditions and requirements within the Transfer Payment Agreement.

  • 014-4347-84
    Request for Major Eye Examination

    form to be completed by those eligible for eye exams to be covered under OHIP

  • 014-2743-84
    Request for Approval of Payment for Proposed Dental Procedures

    form completed to obtain approval for dental procedures to be carried out in hospital and covered by OHIP

  • 014-7179-84
    Summary of Inpatient Expenses

    form sent to other provinces for reimbursement of inpatient claims paid (reciprocal)

  • 014-1057-82
    (Change of Address form) What's Your Address?

    Form used to update/change address information of OHIP cardholders

  • 014-4908-87
    Initial Request for Compassionate Review Policy

    To help physicians to submit requests for drug funding for their ODB-eligible patients under the Compassionate Review Policy.

  • on00502
    Laboratory Requisition

    Laboratory Requisition Pursuant to the Mandatory Blood Testing Act, 2006 and O. Reg. 449/07 To support implementation of the Mandatory Blood Testing Act, 2006

  • on00462
    Respondent Report

    Form 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, 2006

  • on00461
    Applicant Report

    Form 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, 2006

  • on00460
    Physician Report

    Form 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, 2006

  • 014-4818-69
    Long-Term Care Home Support Document List - Resident Receiving ODSP

    To be used by residents of LTC homes who would like to apply for a reduction in the amount of their basic accommodation fees. This document guides applicants in determining which supporting documents will be required as part of their application. This document is to be used by applicants who are receiving benefits from the Ontario Disability Support Program.