You may use this form if you have applied and are enrolled in the Ontario Seniors Dental Care Program and would like to change the information provided at the time of application. Through this form, you can update applicant information, contact information, marital status and/or spousal information, income declaration, or withdraw consent to disclose personal information and/or personal health information.

The Vendor Registration Application form is an interactive form that will be completed by an Ontario retailer or supplier of home oxygen therapy who is requesting registration with the Assistive Devices Program.

The information on this form is used to determine eligibility for grant assistance under the Assistive Devices Program.

Application form completed by rehabilitation professionals applying to Underserviced Area Program for financial incentives, in return for filling full-time vacancies in MOHLTC fully-funded positions in Northern Ontario.

Form to be completed by providers on behalf of patients seeking prior approval for insured sex-reassignment surgery.

Form completed by clients to record their wishes for organ/tissue donation

Form used so patient can submit out of country medical receipts

Form used by physicians to make inquiries regarding payment details on Remittance Advice

Form outlines the Conformance Testing-Acceptable Use Policy and is part of agreement between ministry and vendor who must successfully pass the conformance testing.

This form is to be used for a patient who is seeking a reduction to the co-payment or for whom a reduction is sought further to the factors set out in section 10 of Reg. 552 under the Health Insurance Act.

form used for out-patient services incurred by visitors from another province

Form used as part of EDT registration package for IHPs

Form to show all group locations where physician services provided

form sent to other provinces for reimbursement of inpatient claims paid (reciprocal)

This form is completed by the person in charge of the secure treatment program once the criteria are met for the child's emergency admission to a secure treatment program.

form used so physicians can have direct deposit of payment of claims

Form that Interdisciplinary Health Providers will complete and sign agreeing to conform to ministry's technical specifications for claims submission in MRI

form submitted with claims to provide additional information regarding particular claim

Form used to change status of OHIP coverage - i.e., change of address, name, citizenship status, etc. or to cancel OHIP coverage or replacement of lost, stolen and damaged card

User Agreement for Pharmacies Requesting Publicly Funded Influenza Vaccine in accordance with the UIIP Prequalification form for health care agencies and workplaces that are required to prequalify in order to receive influenza vaccine.