This form is available on the Ontario Drug Benefit Program Online Applications and Forms website:
https://forms.ontariodrugbenefit.ca/.
If you are not able to complete the form online, please contact the TDP at 416-642-3038 (Toronto area) or 1-800-575-5386 (outside Toronto) for a paper version of this form.
Written consent to release information enables the Assistive Devices Program to provide a history of previously funded equipment/supplies to a client and/or third party as specified.
form to be completed by those eligible for eye exams to be covered under OHIP
Used to apply for Funding Continuous Glucose Monitors (CGM) Supplies
Form created with public health. Eligible uninsured patients diagnosed/treated for TB, physicians submit form to get paid
Used by Toronto Clients to order Biological Supplies from Ontario Government Pharmaceutical and Medical Supply Service.
Used by public health units when conducting cold chain maintenance inspections in premises that store publicly funded vaccines.
Form used by physicians to make inquiries regarding payment details on Remittance Advice
“The Digital Health Drug Repository (DHDR) Reference Guide may be used by health care providers to understand the inclusions and limitations of the information available through the DHDR.”
This form is completed by Public Health Boards when MOH site is down.
form used for out-patient services incurred by visitors from another province
Used by primary care groups who have opted for group enrolment and consent and is only for changing the designated physician of individual patients.
This form is used by Manufacturers to report testing of Powered Mobility Devices
form used so physicians can have direct deposit of payment of claims
This form is completed by Public Health Boards when MOH site is down.
Used by public health units to report vaccine cold chain incidents and wasted or exposed vaccine.
Form used to update/change address information of OHIP cardholders
