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5041-77
Request for Prior Approval for Funding of Sex-Reassignment SurgeryForm to be completed by providers on behalf of patients seeking prior approval for insured sex-reassignment surgery.014-3750-84
Organ and Tissue Donor RegistrationForm completed by clients to record their wishes for organ/tissue donation014-0951-84
Out-of-Province/Out-of-Country Claim SubmissionForm used so patient can submit out of country medical receipts014-0918-84
Remittance Advice InquiryForm used by physicians to make inquiries regarding payment details on Remittance Advice014-4860-84
Vendor Application for Conformance Testing-Acceptable Use PolicyForm outlines the Conformance Testing-Acceptable Use Policy and is part of agreement between ministry and vendor who must successfully pass the conformance testing.014-7521-84
Out of Province Out-patient Servicesform used for out-patient services incurred by visitors from another province014-4721-84
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 provided014-7179-84
Summary of Inpatient Expensesform sent to other provinces for reimbursement of inpatient claims paid (reciprocal)on00326
Emergency Admission to Secure Treatment ProgramThis form is completed by the person in charge of the secure treatment program once the criteria are met for the child's emergency admission to a secure treatment program.014-2404-84
Claims Flagged for Manual Reviewform submitted with claims to provide additional information regarding particular claim014-0280-82
Change of InformationForm used to change status of OHIP coverage - i.e., change of address, name, citizenship status, etc. or to cancel OHIP coverage or replacement of lost, stolen and damaged cardon00557
Meat Inspection Program Animal Health Discussion Request FormThis Meat Inspection Program Discussion Request Form is intended for use when further discussion is requested by producers/consigners and/or herd/flock veterinarians regarding condemnations or dispositions made at provincially licensed meat plants in Ontario and information included on Form 202: Whole and/or Partial Carcass(es) Condemnations.014-0691-84
Request for Approval of Payment for Proposed SurgeryForm to request approval for patient to receive surgery In-Province.on00843
Tuition Support Program for Nurses - Return of Service AgreementReturn-of-service agreement between the ministry and the tuition grant recipienton00841
Tuition Support Program for Nurses - Confirmation of EmploymentConfirmation that an offer and acceptance of employment has been made for nursing serviceson00844
Tuition Support Program for Nurses GuidelinesGuidelines providing an overview of the Tuition Support Program for Nurses014-4551-87
Application and Consent for the Inherited Metabolic Diseases (IMD) ProgramFor physicians and patients to apply for the Inherited Metabolic Disorders (IMD) Program.014-2451-67
Application for Funding Home Oxygen TherapyTo be used for all applications for Home Oxygen Therapy funding.on00323
Application for Funding Real-Time Continuous Glucose Monitoring System (rtCGM)Used to apply for Funding Continuous Glucose Monitors (CGM) Supplies
