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.
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.
This is a form that employees may wish to provide to a qualified health practitioner to fill out, in order to support their eligibility to take this leave.
The purpose of this form is to collect the information required for the Ministry to consider a transfer of Moose Tags between Affiliated Tourist Outfitters under the Ontario Moose-Bear Tourism Industry Program
