PPLBP forms gather necessary information to help determine the applicant eligibility for the program.

The Application Form collects information from applicants regarding their contact information, medical practice and education history.

The eForm is currently unavailable at this time. We would like to have the option to re-activate the eForm at a later date.

Form authorizes the ministry to disclose an individual's personal claims history information directly to a third party.

Physicians complete form to indicate their preference on how malpractice reimbursement will be sent to them.

The Notice of Adverse Test Results and Issue Resolution form is to be used by licensed laboratories and owners/operators of small drinking water systems to support required written notifications pertaining to small drinking water system adverse water quality incidents (AWQI).

This form is used by manufacturers/distributors of mobility equipment (wheelchairs and wheeled walkers) for the purpose of making application to the Assistive Devices Program requesting approval to list their respective products on the list of approved devices.

Certificate of Death – Form 1 to be completed by an attending physician or registered nurse in the extended class pursuant to s. 17(2)(a) of Reg. 965 – Hospital Management made under the Public Hospitals Act.

This form is an order completed by the Chair of the Child and Family Services Review Board either releasing the child from the secure treatment program or denying the application.

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.

IHPs requesting approval to submit their claims in MRI format

Amendments to Regulation 854 for Mines and Mining Plants made under the Occupational Health and Safety Act, which came into effect on January 1, 2012, included changes to the medical certificate prescribed under section 238 of the regulation. Under these provisions, operators of mine hoists are required to undergo a yearly medical examination by a physician. The certificate, which is completed by the physician, provides a convenient way for stakeholders to comply with these requirements. The certificate will take less than five minutes to complete.

A parent must complete a Statement of Conscience or Religious Belief and have it witnessed by a commissioner for taking affidavits if they wish to obtain a non-medical exemption for their child from vaccine requirements under the Immunization of School Pupils Act.

A physician or nurse practitioner must complete a Statement of Medical Exemption for children who require a medical exemption from vaccine requirements under the Immunization of School Pupils Act.

Application used to determine eligibility for funding by ADP for Hearing Devices.

Complete this voluntary aid (Clinician Aid C) if you have been asked by a “Medical Practitioner” or “Nurse Practitioner” to provide a written opinion confirming that the Patient meets the eligibility criteria to receive medical assistance in dying. You should also include the completed aid in the patient's medical records.

The use of this aid is voluntary. It is being provided to assist you in maintaining records for medical assistance in dying. Please use this aid if you are a “Medical Practitioner” or “Nurse Practitioner” and a patient is requesting Advance Consent for MAID Self-Administration.

Receive information required to process Personal Claims History information requests from individuals or individual's substitute decision makers.

Used by Toronto clients to return non-reusable vaccines (spoiled or expired) to the Ontario Government Pharmaceutical and Medical Supply Service

The Record Keeping Template – This guidance tool is one way that an employer can record the basic occupational health and safety awareness training for their workers and supervisors. This guidance tool is a sample template.