This 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 Portal
The Vendor Registration Application form is an interactive form that will be completed by an Ontario retailer or supplier of assistive devices who is requesting registration with the Assistive Devices Program.
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.
The ICHSC Program must be notified of a change in quality assurance advisor through the submission of the Quality Assurance Advisor form which must be signed by both the centre’s quality assurance advisor and the licensee.
Transfer of ownership of Integrated Community Health Services Centre (ICHSC) licence.
The 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.
Used by Ministry clients to order forms from OSS Distribution.
Application used to determine eligibility for funding by ADP for Hearing Devices.
Universal Influenza Immunization Program Reimbursement Form for influenza immunization clinics that are eligible for reimbursement through the Universal Influenza Immunization Program.
Used by Canadian board -certified orthotists registered with ADP to request funding for custom -made orthoses
The application form is for candidates who have either successfully completed the Paramedic training program provided by an approved College or Training Institution or have been considered equivalent through the MOH Standard Paramedic Equivalency Process and wish to write to write the Ministry of Health (MOH) Advanced Emergency Medical Care Assistant (AEMCA) examination.
Return-of-service agreement between the ministry and the tuition grant recipient
Consent to collect and disclose personal information about the Canadian university, college, and/or facility the applicant has graduated from and the facility they will be completing their return-of-service at.
Confirmation that an offer and acceptance of employment has been made for nursing services
The purpose of this form is for a patient to provide their consent to disclose Personal Health Information to a an NHTG program-approved Third-Party Agency and agree to direct the ministry to pay the entirety of the eligible Northern Health Travel Grant amount to the approved Third-Party Agency listed in the form.
Used to apply for Funding for Visual Aids
