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1617-88
Statement of ExpensesStatement of Expense for Health Care Providers and Allied Health Care Professionals.014-4519-45
Do Not Resuscitate Confirmation FormUsed by Health Care Facility Staff and Regulated Health Care Providers. Submit completed order request form (available at https://forms.mgcs.gov.on.ca/en/dataset/014-0350-93) to OSSDistribution@ontario.ca.014-5055-67
Authorizer Registration Change RequestTo maintain registration of health care professionals, termed authorizers, by the Assistive Devices Program014-0265-82
Registration for Ontario Health CoverageForm is used to register new or returning Ontario residents or renew photo Health Card and contains instructions/information.013-1910
Notice of Revocation of WaiverUsed by a taxpayer to revoke a waiver of time limit for issuing assessments or reassessments previously issued, under the Employer Health Tax.014-4919-57
Request for Rights Advice Community Treatment Order (CTO)Used by Mental Health Professional to request Rights Advice for both patient and SDM (if indicated). Form completed when Community Treatment Plan (CTP) and Form 49 are issued by physician. Form, CTP and Form 49 faxed to PPAO.016-1938
Multi-workplace Joint Health and Safety Committee Self-evaluation ChecklistThis Self-evaluation checklist has been developed to assist you in the process of applying for a Multi-workplace Joint Health and Safety Committee (MJHSC) granted under a Minister's Order pursuant to subsection 9(3.1) of the Occupational Health and Safety Act.014-06-5040
Long-Term Care Home Inspection Report RequestAll Long-Term Care Home (LTCH) Inspection reports are posted on the Long-Term Care Homes public website (http://publicreporting.ltchomes.net/en-ca/default.aspx), in English. To request an accessible version or a French version of an Inspection report for a specific LTCH, please complete this form and submit it to the Health Data Branch (HDB), Ministry of Health and Long-Term Care.014-4590-64
Response to Adverse Drinking Water Quality Incidents - ResolveThis form is completed by Public Health Boards when MOH site is down.014-4589-64
Response to Adverse Drinking Water Quality Incidents - IssueThis form is completed by Public Health Boards when MOH site is down.014-4564-85
Licence Transfer ApplicationTransfer of ownership of Integrated Community Health Services Centre (ICHSC) licence.013-1909
Waiver of Time Limit for Issuing ReassessmentsWaive time limits for assessments and reassessments under Employer Health Tax014-4574-64
Vaccine Cold Chain Maintenance Inspection ReportUsed by public health units when conducting cold chain maintenance inspections in premises that store publicly funded vaccines.014-4575-64
Vaccine Cold Chain Incident Exposure/Wastage ReportUsed by public health units to report vaccine cold chain incidents and wasted or exposed vaccine.on00314
Request for Prior Approval for Full Payment of Insured Out-of-Country (OOC) Health ServicesThis form is meant to be submitted by a practicing Ontario physician on behalf of their patients to request consideration of funding for out-of-country health services. Along with the completed application form, submissions must also include relevant medical documentation.016-2028
Supporting Ontario's Safe Employers (SOSE) Occupational Health and Safety Management System (OHSMS) Accreditation ApplicationThis is the application form a organization must complete and submit to the Chief Prevention Officer, pursuant the authority under subsection 7.6.1 of the Occupational Health and Safety Act (OHSA), for the purpose of the CPO accrediting the organization's Occupational Health and Safety Management System (OHSMS).
