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014-1057-82
(Change of Address form) What's Your Address?Form used to update/change address information of OHIP cardholders014-5069-87
Drug Benefit Claim Reversal FormUsed by pharmacies for submitting claims or reversals014-2784-87
Drug Benefit Claim Submission FormUsed by pharmacies for submitting claims014-6429-41
Form 3 - Certificate of Involuntary Admission014-6428-41
Form 2 - Order for Examination under Section 16014-3760-41
Form 45 - Community Treatment Order014-3056-64
Daily Record of Spa Operation014-1667-88
Application for Physician Locum Programs014-4282-64
Prequalification Form for Organizations Requesting Publicly Funded Influenza Vaccine for the 2026/2027 Universal Influenza Immunization Program (UIIP)Prequalification form for health care agencies and workplaces that are required to prequalify in order to receive influenza vaccine.014-4930-87
Request to Remove a Household Member(s) from the Trillium Drug ProgramThis 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.4970-47
Diabetes Education Patient Take Home SummaryThe 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.014-1265-84
Health Number ReleaseHospitals submit form to ministry to obtain Health Number of patient when number is not available014-3693-87
Trillium Drug Program ApplicationThe 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.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.
