269 Forms found for CSR-13A-20-F

Ministries: Ministry of Health

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  • 014-5036-64
    Healthy Smiles Ontario - Ontario Works First Nations Verification Form

    First Nations clients receiving Ontario Works will fill out this form and mail it to the HSO Program Administrator in order to enroll in the Healthy Smiles Ontario Program.
  • 014-06-5040
    Long-Term Care Home Inspection Report Request

    All Long-Term Care Home (LTCH) Inspection reports are posted on the Long-Term Care Homes public website (http://publicreporting.ltchomes.net/en-ca/default.aspx), in English. To request an accessible version or a French version of an Inspection report for a specific LTCH, please complete this form and submit it to the Health Data Branch (HDB), Ministry of Health and Long-Term Care.
  • on00159
    COVID-19 Vaccine Cold Chain Incident Exposure/Wastage Report

    Record and report COVID-19 cold chain failures by hospitals and long-term care homes to public health units and the ministry.
  • on00028
    Form P5

    Application to the Board to Amend the Conditions of, or Terminate the Appointment of a Representative under Subsection 27(7) or (8) of the Personal Health Information Protection Act.
  • 4970-47
    Diabetes Education Patient Take Home Summary

    The MedsCheck for Diabetes includes an Annual review that involves using the pharmacist's worksheet and providing the patient with a MedsCheck Personal Medication Record; as well as using a Diabetes Education Checklist and providing the patient with a Diabetes Education Patient Take-Home Summary.
  • 014-4908-87
    Initial Request for Compassionate Review Policy

    To help physicians to submit requests for drug funding for their ODB-eligible patients under the Compassionate Review Policy.
  • 014-4603-82
    Change your home address

    Change your address for your driver's licence, vehicle registration, health card and Outdoors Card quickly and easily in one secure, simple transaction. You can choose to notify one or more of three ministries of your address change – Ministry of Transportation, Ministry of Health and Long-Term Care, and Ministry of Natural Resources.
  • 014-1265-84
    Health Number Release

    Hospitals submit form to ministry to obtain Health Number of patient when number is not available
  • 014-4816-69
    Rate Reduction Application in Long-Term Care - Document List Required for Assessment of Resident without NOA

    To be used by residents of LTC homes who would like to apply for a reduction in the amount of their basic accommodation fees. This document guides applicants in determining which supporting documents will be required as part of their application. This document is to be used by applicants who do not have a Notice of Assessment.
  • 014-4815-69
    Rate Reduction Application in Long-Term Care - Document List Required for Assessment of Resident Eligibly

    To be used by residents of LTC homes who would like to apply for a reduction in the amount of their basic accommodation fees. This document guides applicants in determining which supporting documents will be required as part of their application. This document is to be used by applicants who have a Notice of Assessment.
  • 014-5048-45
    AEMCA Examination Application

    The application form is for candidates who have either successfully completed the Paramedic training program provided by an approved College or Training Institution or have been considered equivalent through the MOH Standard Paramedic Equivalency Process and wish to write to write the Ministry of Health (MOH) Advanced Emergency Medical Care Assistant (AEMCA) examination.
  • 014-3233-87
    Seniors Co-Payment Program Application

    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.
  • on00161
    MOH CYMH Service Description Schedules

    The Service Description Schedule is part of the Transfer Payment Agreement between His Majesty the King in right of Ontario as represented by the Minister of Health (“the Province”) and the Transfer Payment Recipient. The Transfer Payment Recipient will deliver the programs and services in accordance with the requirements as outlined in this Service Description Schedule document in addition to all conditions and requirements within the Transfer Payment Agreement.
  • 5128
    Ontario Seniors Dental Care Program. Change of Information

    You may use this form if you have applied and are enrolled in the Ontario Seniors Dental Care Program and would like to change the information provided at the time of application. Through this form, you can update applicant information, contact information, marital status and/or spousal information, income declaration, or withdraw consent to disclose personal information and/or personal health information.
  • 014-3693-87
    Trillium Drug Program Application

    The Trillium Drug 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 TDP at 416-642-3038 (Toronto area) or 1-800-575-5386 (outside Toronto) for a paper version of this form.
  • on00502
    Laboratory Requisition

    Laboratory Requisition Pursuant to the Mandatory Blood Testing Act, 2006 and O. Reg. 449/07 To support implementation of the Mandatory Blood Testing Act, 2006
  • on00462
    Respondent Report

    Form 3 - Respondent Report - Pursuant to the Mandatory Blood Testing Act, 2006 and O. Reg. 449/07 To support implementation of the Mandatory Blood Testing Act, 2006
  • on00461
    Applicant Report

    Form 2 - Applicant Report - Pursuant to the Mandatory Blood Testing Act, 2006 and O. Reg. 449/07 To support implementation of the Mandatory Blood Testing Act, 2006
  • on00460
    Physician Report

    Form 1 - Physician Report Pursuant to the Mandatory Blood Testing Act, 2006 and O. Reg. 449/07 To support implementation of the Mandatory Blood Testing Act, 2006
  • 014-5035-64
    Healthy Smiles Ontario Parent Notification Preventive Services Only Stream (HSO-PSO)

    This form is to be used by Public Health Units after dental screening to notify parents/guardians that their child would benefit from preventive dental services. If the parent/guardian can complete the form and return it to the Public Health Unit if they wish to enroll their child into the Preventive Services Only Stream of Healthy Smiles Ontario.