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.
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.
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.
Application for reimbursement of cost due to use of Visudyne
Form used to register specific migrant farm workers for OHIP number
Use this form if you ordered drugs and/or medical supplies from OGPMSS and wish to return resalable drugs and/or medical supplies to OGPMSS. OGPMSS will only accept returns and provide credit for resalable drugs or supplies that meet the criteria listed on the form. OGPMSS will provide you with a Return Authorization Number within 2 business days upon receipt of a completed form.
form to be completed by those eligible for eye exams to be covered under OHIP
Eligibility Criteria for Trivalent Inactivated Influenza Vaccine.
Used by clients to request funding assistance for Insulin Pumps and Supplies for Children
Used by Toronto Clients to order Biological Supplies from Ontario Government Pharmaceutical and Medical Supply Service.
