This form is completed by Public Health Boards when MOH site is down.

form used for inpatients to Ontario hospitals who are here visiting from other provinces

Application form completed by physicians to apply to Northern Physician Retention Initiative for financial incentives.

Hospitals submit form to ministry to obtain Health Number of patient when number is not available

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.

form to be completed by those eligible for eye exams to be covered under OHIP

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.