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014-4478-84
Adjustmentonline form to be available to providers and to Regional Operations staff on a permanent basis on the internet014-9998-82
Ontario Health Insurance Plan (OHIP) Document ListThis is accompaniment to Registration for OHIP & Change of Information forms. Lists acceptable ID documents when applying for Ontario health coverage.014-4550-88
Application for Tuition Support Program for NursesApplication form completed by nursing candidates to apply to Tuition Support Program for Nurses for financial incentives.014-4590-64
Response to Adverse Drinking Water Quality Incidents - ResolveThis form is completed by Public Health Boards when MOH site is down.4975-47
MedsCheck Patient Acknowledgement of Professional Pharmacy ServiceThe ministry is introducing an annual process for patient acknowledgement of professional pharmacy services. This is facilitated with the use of a mandatory form and when completed by the patient confirms the patient's understanding of MedsCheck.014-4882-83
Oral and Maxillofacial Rehabilitation Program (OMRP) ApplicationForm allows providers to refer patients for assessment for the program and will be used by hospital sites to record patient eligibility.014-4589-64
Response to Adverse Drinking Water Quality Incidents - IssueThis form is completed by Public Health Boards when MOH site is down.5128
Ontario Seniors Dental Care Program. Change of InformationYou 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.on00026
Healthy Smiles Ontario - Application Through GuarantorHealthy Smiles Ontario Application Through Guarantor form for the core services stream of the program. This form applies to applicants who do not have a valid SIN or have not filed taxes with the CRA, and a guarantor is required to support registration and eligibility adjudication.on00704
2024 Physician Assistant (PA) Career Start- CONTACT, RECRUITMENT AND FINANCIAL (CRF) FORMThe form collects contact, recruitment and financial information from applicants who have successfully recruited PA graduates.on00703
2024 Physician Assistant (PA) Career Start Grant Application FormThe Application form collects information from employers to determine their eligibility for funding through the PA Career Start Program.014-5050-67
Vendor Registration Application - Home Oxygen TherapyThe 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.014-1945-67
Application for Funding Ostomy GrantThe information on this form is used to determine eligibility for grant assistance under the Assistive Devices Program.014-2352-88
Application for Rehabilitation Incentive GrantApplication 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.5041-77
Request for Prior Approval for Funding of Sex-Reassignment SurgeryForm to be completed by providers on behalf of patients seeking prior approval for insured sex-reassignment surgery.014-3750-84
Organ and Tissue Donor RegistrationForm completed by clients to record their wishes for organ/tissue donation014-0951-84
Out-of-Province/Out-of-Country Claim SubmissionForm used so patient can submit out of country medical receipts014-0918-84
Remittance Advice InquiryForm used by physicians to make inquiries regarding payment details on Remittance Advice014-4860-84
Vendor Application for Conformance Testing-Acceptable Use PolicyForm outlines the Conformance Testing-Acceptable Use Policy and is part of agreement between ministry and vendor who must successfully pass the conformance testing.014-3266-54
Application for Reduction of Assessed Co-payment FeesThis 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.