This form is used by manufacturers/distributors of mobility equipment (wheelchairs and wheeled walkers) for the purpose of making application to the Assistive Devices Program requesting approval to list their respective products on the list of approved devices.
Provider/hospital applies for Interactive Voice Response to verify Health Card numbers via telephone
Healthy Smiles Ontario General Application form for the core services stream of the program. This form applies to applicants that have a valid SIN and have filed a statement of income or a tax return with the CRA.
The Seniors Co-Payment Program Application 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 SCP at 416-503-4586 (Toronto area) or 1-888-405-0405 (outside Toronto) for a paper version of this form.
Licensees of Integrated Community Health Services Centres (ICHSCs) must submit an application and obtain written approval from the Director of Integrated Community Health Services Centres prior to a centre’s relocation. For the purposes of this application, a “Fixed Site” centre is a licensed ICHSC where the Limitations and Conditions of the licence specify a single geographic location or address where specified services may be provided.
Used to apply for Funding for Visual Aids
For Specialist physician & ADP registered authorizers to request funding for extraoral (facial) prostheses.
For Specialist physician & ADP registered authorizer to request funding for intraoral (mouth) prostheses.
Used by clients to apply for funding for a silicone breast prosthesis(es)
Application used by Homemaker and Nurses to request reimbursement from the Province for services provided.
Used to apply for Funding for Ventilator Equipment and Supplies
Application for reimbursement of cost due to use of Visudyne
Form used to register specific migrant farm workers for OHIP number
Used by clients to request funding assistance for Insulin Pumps and Supplies for Children
Eligibility Criteria for Trivalent Inactivated Influenza Vaccine.
Used by Toronto Clients to order Biological Supplies from Ontario Government Pharmaceutical and Medical Supply Service.
