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014-4929-87
Trillium Drug Program Application Signature RequestThis form 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 TDP at 416-642-3038 (Toronto area) or 1-800-575-5386 (outside Toronto) for a paper version of this form.014-4658-67
Application for Funding Ocular ProsthesesUsed to apply for Funding for Ocular Prostheses014-2859-69
Application for Services Form 1Application for services of a homemaker or a nurse014-4508-67
Insulin Pump Product EvaluationUsed to evaluate Insulin pumps4967-47
Pharmacists WorksheetMust be completed for every MedsCheck; pharmacists must have professional notes and/or a worksheet when conducting a MedsCheck.014-4258-82
Health Card Renewal - ChildForm is generated by client communication system.on00842
Tuition Support Program for Nurses - Consent to Collection and Disclosure of Personal InformationConsent to collect and disclose personal information about the Canadian university, college, and/or facility the applicant has graduated from and the facility they will be completing their return-of-service at.014-4777-87
Request for Zavesca® - Niemann Pick Type C (NPC)To facilitate prescribers making reimbursement claims for treatment of Niemann Pick Type C (NIPC).014-4717-87
Submission of Patient EvidenceTo provide patient advocacy groups with a template for written submissions to the ministry on a drug; the form is to make sure all the appropriate information is provided.014-4347-84
Request for Major Eye Examinationform to be completed by those eligible for eye exams to be covered under OHIP014-7521-84
Out of Province Out-patient Servicesform used for out-patient services incurred by visitors from another province014-3759-83
Community Treatment Order (CTO) Report Logform used to provide patient with a comprehensive plan of community-based treatment or care and supervision.014-3164-84
Health Card Medical Exemption RequestForm completed to request exemption, i.e., no photo to appear on photo health card
