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014-3523-87
Ontario Drug Programs Enrollment Form -
014-3134-84
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 groupon00520
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.
