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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.014-3523-87
Ontario Drug Programs Enrollment Form014-3134-84
Application For IVR ParticipationProvider/hospital applies for Interactive Voice Response to verify Health Card numbers via telephoneon00159
COVID-19 Vaccine Cold Chain Incident Exposure/Wastage ReportRecord and report COVID-19 cold chain failures by hospitals and long-term care homes to public health units and the ministry.014-4858-87
Request for Ilaris® (canakinumab)Application for drug funding014-4901-97
Requisition for NaloxoneRequisition for Naloxone014-4638-67
Authorizer Application - Attachment BAuthorizer Application - Attachment B014-4652-87
Request for Myozyme®014-2983-88
Confirmation of Payment Instruction014-0403-67
Application for Authorizer StatusApplication for Authorizer Status014-4323-04
Notice of Withdrawal014-3887-41
Home Staff Change Notification014-3884-41
Review Findings014-3883-41
Program Funding Request014-3653-41
Dental Claim014-3143-04
New Accused Information Sheet014-2002-41
Approval to Purchase Clothing014-5035-64
Healthy Smiles Ontario Parent Notification Preventive Services Only Stream (HSO-PSO)This form is to be used by Public Health Units after dental screening to notify parents/guardians that their child would benefit from preventive dental services. If the parent/guardian can complete the form and return it to the Public Health Unit if they wish to enroll their child into the Preventive Services Only Stream of Healthy Smiles Ontario.014-4742-84
Application for IHP Group RegistrationForm will be used by IHPs to form a registered group
