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014-4820-67
Application for Funding Maxillofacial Intraoral ProsthesesFor Specialist physician & ADP registered authorizer to request funding for intraoral (mouth) prostheses.014-4392-67
Application for Funding Breast Prosthesis GrantUsed by clients to apply for funding for a silicone breast prosthesis(es)014-2860-69
Application for Reimbursement by The ProvinceApplication used by Homemaker and Nurses to request reimbursement from the Province for services provided.014-4792-67
Application for Funding Ventilator Equipment and SuppliesUsed to apply for Funding for Ventilator Equipment and Supplies014-3975-87
Visudyne Therapy Registration/Funding EnrollmentApplication for reimbursement of cost due to use of Visudyne014-3715-82
Seasonal Agricultural Workers Registration for Ontario Health CoverageForm used to register specific migrant farm workers for OHIP number014-4446-67
Application for Funding Insulin Pumps and Supplies for ChildrenUsed by clients to request funding assistance for Insulin Pumps and Supplies for Children014-4344-64
Influenza Vaccine Order Form for the Universal Influenza Immunization ProgramEligibility Criteria for Trivalent Inactivated Influenza Vaccine.014-2203-64
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.014-4574-64
Vaccine Cold Chain Maintenance Inspection ReportUsed by public health units when conducting cold chain maintenance inspections in premises that store publicly funded vaccines.014-4846-87
Request for Aldurazyme®To facilitate prescribers making reimbursement claims for treatment of Hurler-Scheie and Hurler disease014-4746-84
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 cardholders
