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Form Y5Application to the Board to Amend the Conditions of, or Terminate the Appointment of a Representative under Subsection 305(8) or (9) of the Child, Youth and Family Services Act.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 Act014-0280-82
Change of InformationForm used to change status of OHIP coverage - i.e., change of address, name, citizenship status, etc. or to cancel OHIP coverage or replacement of lost, stolen and damaged card014-4316-84
Patient Enrolment Batch Headerform placed on top of bundles of primary care forms, to submit to ministry for processing.014-4500-69
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 Officeron00520
Relocation Application (Fixed Site)Licensees of Integrated Community Health Services Centres (ICHSCs) must submit an application and obtain written approval from the Director of Integrated Community Health Services Centres prior to a centre’s relocation. For the purposes of this application, a “Fixed Site” centre is a licensed ICHSC where the Limitations and Conditions of the licence specify a single geographic location or address where specified services may be provided.014-5069-87
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 Program014-4509-67
Application for Equipment Listing Insulin PumpsUse by vendor/manufacturer to apply for equipment listing insulin pumps.014-4853-44
Reinstating Access to Information in the Ontario Laboratories Information System (OLIS)Complete this form if you wish to have the Ministry of Health and Long-Term Care reinstate your laboratory test information in the Ontario Laboratories Information System (OLIS) after your lab test has been completed.
