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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 Information012-2031
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.on00496
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for an order opening crown mining rights in OntarioThis form is used by surface rights holder(s) to make the withdrawn mining rights available for claim registration.on00495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 claim014-1265-84
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.on00646
Ontario Disability Support Program (ODSP) - Mandatory Special Necessities (MSN) Benefit ApplicationApplication may only be completed for recipients of ODSP. The following approved health care professionals licensed to practice in Ontario can complete the application: • Physicians, Nurse Practitioners, Registered Nurses, Occupational Therapists, Physiotherapists, Physician Assistants, and Psychologists* *Psychologists can only complete the Medical Transportation section of the form. The application may only be completed for medical supplies, items, and devices listed in the MSN Schedule of Benefits (https://www.ontario.ca/page/ontario-disability-support-program-health-and-disability-benefits) and items must not be otherwise reimbursed or subject to reimbursement from any other source.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.on00607
Raptor Log bookThe Fish and Wildlife Conservation Act, 1997, and O.Reg. 668/98 (Wildlife in Captivity) requires that a person who keeps specially protected raptors or non-indigenous falconry birds in captivity keep a log book. Log books must be updated within 24 hours of any business transaction or event, or as soon as reasonably possible. Log book records need to be kept for five years and must be accurate.on00608
Annual Report of All Specially Protected Raptors PossessedThe Fish and Wildlife Conservation Act, 1997, and O.Reg. 668/98 (Wildlife in Captivity) requires a person who keeps specially protected raptors in captivity to submit an annual report of all of the specially protected raptors they possessed to the Ministry of Natural Resources and Forestry. The person must also keep a copy of the annual report for five years.on00536
Low-Volume Claim Submission Claim File GeneratorThe "Low-Volume Claim Submission Claim File Generator" is a tool that allows registered Health Care Professionals/Registered Third-Party Billing Agencies (RTPBAs) to generate a claim file that can be securely submitted to the ministry electronically for the purpose of payment.
