form used so that new patient to primary health group can join that group due to reasons on form

form used, in urgent cases (i.e. patient was in hospital, newborn in NICU) where patient has no family physician so can join primary group.

The form is used to confirm a physician's qualifications to provide the requested services prior to processing a request to affiliate to a particular ICHSC. The licensee must ensure that the physician has been affiliated to the centre before they begin to provide licensed services.

You 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.