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014-4347-84
Request for Major Eye Examinationform to be completed by those eligible for eye exams to be covered under OHIP014-4344-64
Influenza Vaccine Order Form for the Universal Influenza Immunization ProgramEligibility Criteria for Trivalent Inactivated Influenza Vaccine.014-4446-67
Application for Funding Insulin Pumps and Supplies for ChildrenUsed by clients to request funding assistance for Insulin Pumps and Supplies for Children014-2203-64
Toronto Clients Requisition for Biological Supplies (for use in M postal code areas only)Used by Toronto Clients to order Biological Supplies from Ontario Government Pharmaceutical and Medical Supply Service.014-4846-87
Request for Aldurazyme®To facilitate prescribers making reimbursement claims for treatment of Hurler-Scheie and Hurler disease014-2861-69
Consent to Inspect Assets Form 2Used to determine whether a person who is eligible for homemaking and nurses services is required to pay the fees prescribed for the services.014-4746-84
Interdisciplinary Health Provider (IHP) Health Number ReleaseForm submitted to ministry to obtain Health Number of patient when not available014-4500-69
Determination of Available Monthly Income Form 4Used for the determination of applicant's available monthly income.014-1057-82
(Change of Address form) What's Your Address?Form used to update/change address information of OHIP cardholderson00521
Exceptional Access Program (EAP) – Biosimilar Exemption RequestThis form is only to be used by prescribers to request an exemption for Ontario’s Biosimilar Switch Policy for a patient who HAS BEEN USING AN ORIGINATOR BIOLOGIC REIMBURSED THROUGH THE ONTARIO DRUG BENEFIT (ODB) PROGRAM previously authorized through the Exceptional Access Program and is unable to switch from an originator biologic or who is requesting to switch back to the originator following biosimilar switch.014-5069-87
Drug Benefit Claim Reversal FormUsed by pharmacies for submitting claims or reversals014-4420-84
Health Claim014-2784-87
Drug Benefit Claim Submission FormUsed by pharmacies for submitting claims014-6429-41
Form 3 - Certificate of Involuntary Admission
