English - 014-4900-85e - Physician Affiliation...
Dataset description:
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...
Source: Physician Affiliation Authorization and Declaration of Professional Standing for ICHSCs
Additional Information
| Last updated | April 24, 2026 |
|---|---|
| Created | December 11, 2021 |
| Format | application/pdf |
| Form Number | https://forms.mgcs.gov.on.ca/dataset/d88192d9-153c-4c4b-b676-530cfd19dbfb/resource/f3e5f65e-5b1c-4969-aa0c-ba79166f11d7/download/4900-85e.pdf |
| Form File Identifier | 014-4900-85e |
| Name | English - 014-4900-85e - Physician Affiliation Authorization and Declaration of Professional Standing for ICHSCs |
| Form File Status | Available |
| Description | |
| Language | English |
| Functionality | Fill, Print, and Save |
| Form File Content Type | Form |
| Remark | |
| Edition Date | 2026-04 |