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on00843
Tuition Support Program for Nurses - Return of Service AgreementReturn-of-service agreement between the ministry and the tuition grant recipienton00841
Tuition Support Program for Nurses - Confirmation of EmploymentConfirmation that an offer and acceptance of employment has been made for nursing serviceson00844
Tuition Support Program for Nurses GuidelinesGuidelines providing an overview of the Tuition Support Program for Nurses014-4344-64
Influenza Vaccine Order Form for the Universal Influenza Immunization ProgramEligibility Criteria for Trivalent Inactivated Influenza Vaccine.014-0691-84
Request for Approval of Payment for Proposed SurgeryForm to request approval for patient to receive surgery In-Province.3977-84
Health Care Provider Claim - Diagnostic and Treatment ServicesForm created with public health. Eligible uninsured patients diagnosed/treated for TB, physicians submit form to get paid014-1948-95
Application for Direct Bank Payment - ADPUsed by clients/vendors to receive remuneration by direct deposit versus cheque.014-3750-84
Organ and Tissue Donor RegistrationForm completed by clients to record their wishes for organ/tissue donation014-0951-84
Out-of-Province/Out-of-Country Claim SubmissionForm used so patient can submit out of country medical receipts014-0918-84
Remittance Advice InquiryForm used by physicians to make inquiries regarding payment details on Remittance Advice014-4860-84
Vendor Application for Conformance Testing-Acceptable Use PolicyForm outlines the Conformance Testing-Acceptable Use Policy and is part of agreement between ministry and vendor who must successfully pass the conformance testing.014-7521-84
Out of Province Out-patient Servicesform used for out-patient services incurred by visitors from another province014-7698-84
Application for OHIP Direct Bank Payment for Health Care Professionalsform used so physicians can have direct deposit of payment of claims014-2404-84
Claims Flagged for Manual Reviewform submitted with claims to provide additional information regarding particular claim014-4316-84
Patient Enrolment Batch Headerform placed on top of bundles of primary care forms, to submit to ministry for processing.014-06-5040
Long-Term Care Home Inspection Report RequestAll Long-Term Care Home (LTCH) Inspection reports are posted on the Long-Term Care Homes public website (http://publicreporting.ltchomes.net/en-ca/default.aspx), in English. To request an accessible version or a French version of an Inspection report for a specific LTCH, please complete this form and submit it to the Health Data Branch (HDB), Ministry of Health and Long-Term Care.014-2352-88
Application for Rehabilitation Incentive GrantApplication form completed by rehabilitation professionals applying to Underserviced Area Program for financial incentives, in return for filling full-time vacancies in MOHLTC fully-funded positions in Northern Ontario.014-4917-67
Vendor Registration ApplicationThe Vendor Registration Application form is an interactive form that will be completed by an Ontario retailer or supplier of assistive devices who is requesting registration with the Assistive Devices Program.014-5048-45
AEMCA Examination ApplicationThe application form is for candidates who have either successfully completed the Paramedic training program provided by an approved College or Training Institution or have been considered equivalent through the MOH Standard Paramedic Equivalency Process and wish to write to write the Ministry of Health (MOH) Advanced Emergency Medical Care Assistant (AEMCA) examination.on00842
Tuition Support Program for Nurses - Consent to Collection and Disclosure of Personal InformationConsent to collect and disclose personal information about the Canadian university, college, and/or facility the applicant has graduated from and the facility they will be completing their return-of-service at.
