120 Forms found for example-of-a-medical-license-number

Formats: PDF

Filter Results
  • 014-0951-84
    Out-of-Province/Out-of-Country Claim Submission

    Form used so patient can submit out of country medical receipts
  • 4969-47
    Diabetes Education Checklist

    The MedsCheck for Diabetes includes an Annual review that involves using the pharmacist's worksheet and providing the patient with a MedsCheck Personal Medication Record; as well as using a Diabetes Education Checklist and providing the patient with a Diabetes Education Patient Take-Home Summary.
  • 4970-47
    Diabetes Education Patient Take Home Summary

    The MedsCheck for Diabetes includes an Annual review that involves using the pharmacist's worksheet and providing the patient with a MedsCheck Personal Medication Record; as well as using a Diabetes Education Checklist and providing the patient with a Diabetes Education Patient Take-Home Summary.
  • 014-5125-20
    Ontario Seniors Dental Care Program Application

    You may use this application form to apply for the Ontario Seniors Dental Care Program if you and your spouse (if applicable) have filed your Personal Tax Return(s) with Canada Revenue Agency (CRA) for the most recent tax year and have a valid Social Insurance Number (SIN). If you have a spouse (married or common law partner) who would also like to apply for the Program, they must complete their own application form.
  • 014-5126-20
    Ontario Seniors Dental Care Program Application Through Guarantor

    You may use this application form to apply for the Ontario Seniors Dental Care Program if you do not have a valid Social Insurance Number (SIN) and/or if you have not filed your Personal Tax Return(s) with Canada Revenue Agency (CRA) for the most recent tax year. If you have a spouse (married or common law partner) who would also like to apply for the Program, they must complete their own application form.
  • on00675
    Surety Bond Template

    This is a surety bond template, which is to be used in the context of temporary help agency and recruiter licensing under the Employment Standards Act, 2000.
  • 2189
    Drinking Water Information - O. Reg. 243/07

    This form is used for registering a facility, updating or revoking an existing registration, the identification of a licensed laboratory or to provide notice of reduce lead sampling.
  • 010-3042
    Statement of Conscience or Religious Belief

    To allow individuals to apply for religious/conscience exemptions for immunizations
  • 018-0488
    Application Form for Cage Aquaculture Facilities in Ontario

    The purpose of this Application Form is to provide MNRF with the necessary information to process and review a request for a new (Type A), revised (Type B) or renewed (Type C) license for Cage Aquaculture Facilities.
  • 011-0027
    Application for Ontario's Home Energy Audit Grant (Program)

    Application Form for entry into the Ontario Home Energy Audit Program for Corporate Owned Residential Properties. Homeowners are required to complete this form with a licensed Energy Advisor during their home energy audit to be eligible for an audit grant. For more information, visit www.ontario.ca/homeneergy
  • on00334
    Clinician Aid D-1 - Waiver of Final Consent

    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 a Waiver of Final Consent. The Waiver of Final Consent is ONLY applicable for individuals whose natural death is reasonably foreseeable (RFND).
  • 014-4579-64
    Notice to Operate or Reopen a Small Drinking Water System

    The Small Drinking Water System Identification form is to be used by owners of small drinking water systems to notify in writing the medical officer of health in the health unit where their system is located before supplying drinking water to users of the system following construction or alteration of the small drinking water system or following a shut-down of the system that lasts longer than seven days.
  • 014-4897-64
    Statement of Conscience or Religious Belief – Immunization of School Pupils Act

    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.
  • 0327-88
    Application for Northern Health Travel Grant

    Used to apply for financial travel assistance by Northern Ontario residents who must travel long distances to access medical specialist services.
  • on00384
    Clinician Aid D-2 – Advance Consent – Self-Administration

    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.
  • 014-3296-64
    Non-Reusable Vaccine (spoiled or expired) Return Record - Toronto Clients

    Used by Toronto clients to return non-reusable vaccines (spoiled or expired) to the Ontario Government Pharmaceutical and Medical Supply Service
  • 011-0022
    Application for Ontario's Home Energy Audit Grant (Program)

    Application Form for entry into the Ontario Home Energy Audit Program. Homeowners are required to complete this form with a licensed Energy Advisor during their home energy audit to be eligible for an audit grant. Please visit the program website at www.ontario.ca/homeenergy for more information.
  • on00168
    Fur Dealer's Return of Pelts Purchased or Received

    It is a regulatory requirement under the Fish and Wildlife Conservation Act, 1997 for licensed fur dealer's to report transactions of the pelts of furbearing mammals to the Ministry of Natural Resources and Forestry. This form provides a mechanism for that mandatory reporting.
  • on00169
    Fur Dealer's Return of Pelts Sold or Disposed of

    It is a regulatory requirement under the Fish and Wildlife Conservation Act, 1997 for licensed fur dealer's to report transactions of the pelts of furbearing mammals to the Ministry of Natural Resources and Forestry. This form provides a mechanism for that mandatory reporting.