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014-4752-84
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 claim012-2031
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.014-1265-84
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.014-4442-97
Return Authorization for Resalable Drugs and Medical SuppliesUse this form if you ordered drugs and/or medical supplies from OGPMSS and wish to return resalable drugs and/or medical supplies to OGPMSS. OGPMSS will only accept returns and provide credit for resalable drugs or supplies that meet the criteria listed on the form. OGPMSS will provide you with a Return Authorization Number within 2 business days upon receipt of a completed form.on00580
Statement of Compliance Packaging Materials and Labels Bearing the Meat Inspection LegendApproved meat products packaged and labelled in a provincially licensed meat plant must ensure they are labelled with a meat inspection legend before they are shipped from the facility. The Statement of Compliance Form is completed by new meat plant licence applicants and existing clients to request a Director’s permission to reproduce the meat inspection legend.006-fro-020
REFRAINING ORDERThis form is used when asking the court for a refraining order to prevent the FRO from suspending a driver's licence. If asking for a refraining order, complete the appropriate sections prior to the court date. If you and the FRO lawyer agree on the conditions for the refraining order, complete the form together and provide it to the court clerk for the judge's approval. If you and the FRO lawyer cannot agree, the court will complete the rest of the information, based on what the judge orders.006-fro-019
SUPPORT DEDUCTION ORDERThe 2 forms are used together each time a court makes a support order. When asking the court to make or change a support order, complete the appropriate sections of these forms prior to the court date. The court will complete the rest of the information, based on what the judge orders.012-1866
Application for a Permit to Perform a Water Extermination in Catch Basins 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 catch basin for the control of mosquito larvae that if allowed to mature to adults could be vectors of West Nile Virus.014-4406-87
Request for an Unlisted Drug Product - Exceptional Access Program (EAP)For faster decisions, prescribers can use the SADIE online portal to submit requests to the Exceptional Access Program (EAP). Sign in through GO Secure (https://www.ebse.health.gov.on.ca) and select SADIE from the services drop-down menu. Visit the SADIE website for more information: http://www.ontario.ca/sadie. Alternatively, this form can be used for submitting requests to the EAP by fax.on00700
Laboratory Licensing and X-Ray Inspection Services Fees PaymentTo facilitate secure and real-time electronic payments for clinical laboratory licences and x-ray facility application fees using debit and credit cards.006-fro-028
ALTERNATIVE PAYMENT ORDERThe alternative payment order allows a support payor to pay by another method rather than by automatic income deductions under a support deduction order. If you are asking the court to make an alternative payment order, complete the appropriate sections of this form prior to your court date. If you or the support recipient has a lawyer, the lawyer will complete the rest of the form based on what the judge orders. If neither of you has a lawyer, provide the form to the court clerk.014-4751-84
Interdisciplinary Health Provider (IHP) Nurse Practitioner (NP) Authorization for Participation in the NP Service Encounter Reporting and Tracking (SERT) InitiativeForm will be used for NPs to become affiliated with an organization and participate in the NP Service Encounter Tracking and Reporting (SERT) Initiative to receive funding from the MOHLTC
