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014-3233-87
Seniors Co-Payment Program ApplicationThe 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.014-4824-67
Application for Funding Visual AidsUsed to apply for Funding for Visual Aids014-4821-67
Application for Funding Maxillofacial Extraoral ProsthesesFor Specialist physician & ADP registered authorizers to request funding for extraoral (facial) prostheses.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.014-3975-87
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 number014-4442-97
Return Authorization for Resalable Drugs and Medical SuppliesUse 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.014-4446-67
Application for Funding Insulin Pumps and Supplies for ChildrenUsed by clients to request funding assistance for Insulin Pumps and Supplies for Children014-4344-64
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.014-4846-87
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.
