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014-7698-84
Application for OHIP Direct Bank Payment for Health Care Professionalsform used so physicians can have direct deposit of payment of claims014-4589-64
Response to Adverse Drinking Water Quality Incidents - IssueThis form is completed by Public Health Boards when MOH site is down.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.014-1057-82
(Change of Address form) What's Your Address?Form used to update/change address information of OHIP cardholders014-3759-83
Community Treatment Order (CTO) Report Logform used to provide patient with a comprehensive plan of community-based treatment or care and supervision.014-3164-84
Health Card Medical Exemption RequestForm completed to request exemption, i.e., no photo to appear on photo health cardon00161
MOH CYMH Service Description SchedulesThe Service Description Schedule is part of the Transfer Payment Agreement between His Majesty the King in right of Ontario as represented by the Minister of Health (“the Province”) and the Transfer Payment Recipient. The Transfer Payment Recipient will deliver the programs and services in accordance with the requirements as outlined in this Service Description Schedule document in addition to all conditions and requirements within the Transfer Payment Agreement.5128
Ontario Seniors Dental Care Program. Change of InformationYou may use this form if you have applied and are enrolled in the Ontario Seniors Dental Care Program and would like to change the information provided at the time of application. Through this form, you can update applicant information, contact information, marital status and/or spousal information, income declaration, or withdraw consent to disclose personal information and/or personal health information.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.014-4818-69
Long-Term Care Home Support Document List - Resident Receiving ODSPTo be used by residents of LTC homes who would like to apply for a reduction in the amount of their basic accommodation fees. This document guides applicants in determining which supporting documents will be required as part of their application. This document is to be used by applicants who are receiving benefits from the Ontario Disability Support Program.5127
Ontario Seniors Dental Care Program. Authorizing or Cancelling a RepresentativeYou may use this form to authorize the program administrator of the Ontario Seniors Dental Care Program to deal with another person (such as your spouse or common-law partner, other family member, friend, or accountant) as your representative for program matters. The same form can be used to cancel a previously-made authorization.
