Health Assessment - Ontario Health atHome
Need help downloading or filling forms?
Please check our Help page for solutions to common issues.
Alert!
PDF Forms will no longer work with older versions of Adobe Reader including Adobe Reader XI. Please update your free Adobe Reader to the latest version from the Acrobat Reader download page so that you can continue to access these forms.
Download Adobe Reader Free Version
Make the most of your experience with accessing, downloading, and filling forms acquired from the Central Forms Repository by watching this brief video overview.
Forms, Links, and Information
-
English - 045-4768-69e - Health Assessment - Ontario Health atHomePDF
-
French - 045-4768-69f - Health Assessment - Ontario Health atHomePDF
-
English - 045-4768-69_GuideE - Guide to the New Health Assessment...PDF
This document describes changes to the Health Assessment Form and how to use...
-
French - 045-4768-69_GuideF - Guide to the New Health Assessment...PDF
This document describes changes to the Health Assessment Form and how to use...
-
English - 045-4768-69_GuideFAQE - Modernized Health Assessment...PDF
Frequently asked questions about the updated Health Assessment Form.
-
French - 045-4768-69_GuideFAQF - Modernized Health Assessment...PDF
Frequently asked questions about the updated Health Assessment Form.
Additional Information
Form Number | 045-4768-69e |
---|---|
Title | Health Assessment - Ontario Health atHome |
Description | PLEASE NOTE: The Health Assessment Form has been updated as of July 7th, 2025. Practitioners are asked to begin using the new form immediately. However, assessments completed using the old form will be accepted by Ontario Health atHome until December 31st, 2025. This form is to be used for completion of the assessment required under the Fixing Long-Term Care Act, 2021 when a person applies for a determination of eligibility for long-term care home admission. The required assessment is of the applicant’s physical and mental health, and the applicant’s requirements for medical treatment and health care. This assessment must be made by a physician or registered nurse. |