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014-2859-69
Application for Services Form 1Application for services of a homemaker or a nurse014-2862-69
Medical Certificate Form 3Application used by First Nations and the North014-4742-84
Application for IHP Group RegistrationForm will be used by IHPs to form a registered group014-1667-88
Application for Physician Locum Programs014-3134-84
Application For IVR ParticipationProvider/hospital applies for Interactive Voice Response to verify Health Card numbers via telephoneon00574
Provider Registration/Change Request FormThis application is to enable currently licensed health care professionals to be able to begin submitting or continue to submit claims to the Ministry of Health (the ministry) for insured services. Options include: • Register for an OHIP Billing Number • Register a Health Care Group • Authorize the ministry to make payments to a health care group on your behalf • Update address, banking, and/or group information • Register for Interactive Voice Response (IVR) • Register for the SAV Portal014-4744-84
IHP Application for Direct Bank PaymentForm used by IHPs to set up direct bank deposit014-4500-69
Determination of Available Monthly Income Form 4Used for the determination of applicant's available monthly income.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.014-4637-67
Application for Rehabilitation Assessor/Fitter/Dispenser StatusApplication for Rehabilitation Assessor/Fitter/Dispenser Status014-3384-83
Application for OHIP Billing Number for Health ProfessionalsPhysicians complete form to apply for OHIP billing number and/or specialty billing number.014-4750-84
Application for IHP GONet Electronic Data Transfer (EDT) ServiceIHPs apply to submit claim information via EDT014-4747-84
Application for IHP Claims Submission and Remittance Advice in Machine Readable Input (MRI)IHPs requesting approval to submit their claims in MRI format014-4815-69
Rate Reduction Application in Long-Term Care - Document List Required for Assessment of Resident EligibilityTo 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 have a Notice of Assessment.014-4816-69
Rate Reduction Application in Long-Term Care - Document List Required for Assessment of Resident without NOATo 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 do not have a Notice of Assessment.014-4521-84
Application for Prior Approval for Full Payment of Insured Out-of-Country (OOC) & Out-of-Province (OOP) Laboratory & Genetics TestingThe OOC/OOP PA Program eForm is designed to be completed and submitted electronically for application for prior approval for full payment of insured Out-of-Country (OOC) & Out-of-Province (OOP) laboratory and genetics testing services. English and French versions can be completed online or downloaded and saved for future use.014-1668-69
Application for a Licence to Establish or Maintain and Operate a Nursing HomeApplication for a Licence to Establish or Maintain and Operate a Nursing Home
