Form used so patient can submit out of country medical receipts

“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.”

To be used by residents of LTC homes who would like to apply for a reduction in the amount of their basic accommodation fees. This document guides applicants in determining which supporting documents will be required as part of their application. This document is to be used by applicants who do not have a Notice of Assessment.

Form used by IHPs to set up direct bank deposit

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.

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 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

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

Pharmacists may provide patients with a MedsCheck Patient Take-Home Summary that is intended to further engage patients in identifying ways to build added awareness in their drug therapy and help to identify therapy-related goals.

form submitted with claims to provide additional information regarding particular claim

Used by public health units to report vaccine cold chain incidents and wasted or exposed vaccine.

form placed on top of bundles of primary care forms, to submit to ministry for processing.

To be used by residents of LTC homes who would like to apply for a reduction in the amount of their basic accommodation fees. This document guides applicants in determining which supporting documents will be required as part of their application. This document is to be used by applicants who have a Notice of Assessment.

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.

For faster decisions, prescribers can use the SADIE online portal to submit requests to the Exceptional Access Program (EAP). Sign in through GO Secure (https://www.ebse.health.gov.on.ca) and select SADIE from the services drop-down menu. Visit the SADIE website for more information: http://www.ontario.ca/sadie. Alternatively, this form can be used for submitting requests to the EAP by fax.

This form is to be used by Public Health Units after dental screening to notify parents/guardians that their child has an emergency and/or essential dental condition(s). Parents/Guardian will complete the form and return it to the Public Health Unit to let them know that the child has initiated treatment or to attest to financial hardship and enroll into the Emergency and Essential Services Stream of Healthy Smiles Ontario.

The Grow Your Own Nurse Practitioner Initiative Application is the application health care organizations must complete to request participation in the Grow Your Own Nurse Practitioner Initiative.