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014-4746-84
Interdisciplinary Health Provider (IHP) Health Number ReleaseForm submitted to ministry to obtain Health Number of patient when not availableon00579
Authorization and Consent Formhe purpose of this form is to collect necessary information to obtain authorized consent and assure identity, under the Freedom of Information and Protection of Privacy Act (FIPPA), for application of services delivered by the Ministry of Health on your behalf (or for a “Health Care Group” in which you are a registered member), including: • Application for an OHIP Billing Number • Changes to Health Care Group Registration Informationon00496
Application for an order opening crown mining rights in OntarioThis form is used by surface rights holder(s) to make the withdrawn mining rights available for claim registration.on00495
Application for lease of surface rightsWhen the holder of a mining lease, mining licence of occupation or patented mining lands needs other surface rights for the purpose of mining, such as infrastructure buildings or tailings ponds, the client must submit this application form.014-4721-84
IHP Electronic Data Transfer (EDT) Undertaking and Acknowledgement for Nurse Practitioners (NP)Form used as part of EDT registration package for IHPs014-4342-84
Primary Care-List of Locations Where Group Serv. are Regularly ProvidedForm to show all group locations where physician services provided014-4752-84
Undertaking by Interdisciplinary Health Providers (IHP) for Participation in Machine Readable Input (MRI)Form that Interdisciplinary Health Providers will complete and sign agreeing to conform to ministry's technical specifications for claims submission in MRI014-2404-84
Claims Flagged for Manual Reviewform submitted with claims to provide additional information regarding particular claim012-2031
Summary of Planned and Completed Pesticide Aerial Applications in Ontario Crown ForestsA person who operates an airborne machine in performing a land extermination on Crown Land is required to make a record of each extermination. This is the form to maintain this summary.012-2027
Application for a Permit to Use a Pesticide for Structural Pest ControlSection 7(1) of the Pesticides Act requires a person to hold a permit issued by the Director for a structural extermination unless exempt under regulation. This application form is for a permit to use a fumigant gas or chloropicrin for any fumigation unless exempt under regulation.012-1867
Application for a Permit to Perform a Water Extermination in Surface Water for West Nile Virus ControlSection 7(2) of the Pesticides Act requires a person to hold a permit issued by the Director for a water extermination. This application form is for a permit to use a pesticide in surface water to control of mosquito larvae that if allowed to mature could be vectors of West Nile Virus.014-1265-84
Health Number ReleaseHospitals submit form to ministry to obtain Health Number of patient when number is not available019-0253
Application for Determination of Surface Rights CompensationIf the owner of surface rights considers that a mining claim holder, of the same land, damaged the owners surface rights and is refusing to compensate the surface rights owner, then that owner can send this form to the Mining and Lands Commissioner.014-4431-84
Primary Health Care Unattached Patient Declarationform used, in urgent cases (i.e. patient was in hospital, newborn in NICU) where patient has no family physician so can join primary group.018-fw1034
Application for a Licence to Own and Operate a Train and Trial AreaThis licence allows an individual or corporation to own and operate a Train and Trial Area. Part A of this form contains the application for the licence and Part B contains the required annual report. Those who wish to apply for this licence must have previously been issued a Licence to Own and Operate a Train and Trial Area, applications for new areas will not be accepted. Applicants must submit Part A and Part B of this form, as well as a copy of their site map.on00462
Respondent ReportForm 3 - Respondent Report - Pursuant to the Mandatory Blood Testing Act, 2006 and O. Reg. 449/07 To support implementation of the Mandatory Blood Testing Act, 2006on00461
Applicant ReportForm 2 - Applicant Report - Pursuant to the Mandatory Blood Testing Act, 2006 and O. Reg. 449/07 To support implementation of the Mandatory Blood Testing Act, 2006on00460
Physician ReportForm 1 - Physician Report Pursuant to the Mandatory Blood Testing Act, 2006 and O. Reg. 449/07 To support implementation of the Mandatory Blood Testing Act, 2006
