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1617-88
Statement of ExpensesStatement of Expense for Health Care Providers and Allied Health Care Professionals.014-4519-45
Do Not Resuscitate Confirmation FormUsed by Health Care Facility Staff and Regulated Health Care Providers. Submit completed order request form (available at https://forms.mgcs.gov.on.ca/en/dataset/014-0350-93) to OSSDistribution@ontario.ca.014-5055-67
Authorizer Registration Change RequestTo maintain registration of health care professionals, termed authorizers, by the Assistive Devices Program014-0265-82
Registration for Ontario Health CoverageForm is used to register new or returning Ontario residents or renew photo Health Card and contains instructions/information.014-4919-57
Request for Rights Advice Community Treatment Order (CTO)Used by Mental Health Professional to request Rights Advice for both patient and SDM (if indicated). Form completed when Community Treatment Plan (CTP) and Form 49 are issued by physician. Form, CTP and Form 49 faxed to PPAO.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.014-4590-64
Response to Adverse Drinking Water Quality Incidents - ResolveThis form is completed by Public Health Boards when MOH site is down.014-4589-64
Response to Adverse Drinking Water Quality Incidents - IssueThis form is completed by Public Health Boards when MOH site is down.014-4564-85
Licence Transfer ApplicationTransfer of ownership of Integrated Community Health Services Centre (ICHSC) licence.014-4603-82
Change your home addressChange your address for your driver's licence, vehicle registration, health card and Outdoors Card quickly and easily in one secure, simple transaction. You can choose to notify one or more of three ministries of your address change – Ministry of Transportation, Ministry of Health and Long-Term Care, and Ministry of Natural Resources.014-4574-64
Vaccine Cold Chain Maintenance Inspection ReportUsed by public health units when conducting cold chain maintenance inspections in premises that store publicly funded vaccines.014-4575-64
Vaccine Cold Chain Incident Exposure/Wastage ReportUsed by public health units to report vaccine cold chain incidents and wasted or exposed vaccine.on00314
Request for Prior Approval for Full Payment of Insured Out-of-Country (OOC) Health ServicesThis form is meant to be submitted by a practicing Ontario physician on behalf of their patients to request consideration of funding for out-of-country health services. Along with the completed application form, submissions must also include relevant medical documentation.014-4579-64
Notice to Operate or Reopen a Small Drinking Water SystemThe Small Drinking Water System Identification form is to be used by owners of small drinking water systems to notify in writing the medical officer of health in the health unit where their system is located before supplying drinking water to users of the system following construction or alteration of the small drinking water system or following a shut-down of the system that lasts longer than seven days.014-3266-54
Application for Reduction of Assessed Co-payment FeesThis form is to be used for a patient who is seeking a reduction to the co-payment or for whom a reduction is sought further to the factors set out in section 10 of Reg. 552 under the Health Insurance Act.
