Government of Ontario: Ministry of Health

Application for IVR Participation

The Ontario Ministry of Health is pleased to offer the Interactive Voice Response (IVR) system to verify Health Cards using a touch tone phone. You will be able to enter a 1 800 or local phone number, key in the Health Number/Version code to be verified, and receive a reply indicating the status of the information entered. There is no charge for this service. You will receive your Personal Identification Number (PIN) and a User Manual. This service is available in accordance with the August 1993 OMA/MOH agreement.

To register for IVR access, complete this form, sign and return to your local Ministry of Health office. Please print below.

Applicant name

Name of hospital/institution (If applicant is in a hospital/institution)

Department name

MOH registration number (Provider no, hospital/Institution no.)

Telephone no.

Address

Postal code

Is this a new address Yes
No

Language preference

French
English

Terms of IVR participation
- Your PIN is for your use or persons designated by you.
- It is your responsibility to ensure that the PIN is used only for the purpose of Health Card verification.
- Misuse of this PIN could result in the termination of your participation in the IVR service.

I accept the conditions of the Terms of IVR Participation, for the purpose of Health Card verification, dated and wish to participate in this service.

_________________________________________
Signed

Date

Information on this form is collected and used under the authority of Clauses 4(2)(c) and (f), section 15 to 18 and section 29 of the Health Insurance Act. Questions about this collection should be directed to: Director, Registration and Claims Branch (613) 548-6559, or your local Ministry of Health office.

3134-84 (95/04)* 7530-5379