267 Forms found for RCP-60A-F

Ministries: Ministry of Health

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  • 014-4955-64
    Healthy Smiles Ontario – Authorizing or Cancelling a Representative

    Paper application required to register via mail. This form is submitted to authorize the MOHLTC (Oshawa) to deal with another person (such as your spouse or common-law partner, other family member, friend, or accountant) as your representative for HSO program matters.
  • 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
  • 014-4815-69
    Rate Reduction Application in Long-Term Care - Document List Required for Assessment of Resident Eligibility

    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.
  • 014-4816-69
    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.
  • 014-3233-87
    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.
  • 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.
  • 014-5125-20
    Ontario Seniors Dental Care Program Application

    You may use this application form to apply for the Ontario Seniors Dental Care Program if you and your spouse (if applicable) have filed your Personal Tax Return(s) with Canada Revenue Agency (CRA) for the most recent tax year and have a valid Social Insurance Number (SIN). If you have a spouse (married or common law partner) who would also like to apply for the Program, they must complete their own application form.
  • 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.
  • 014-5126-20
    Ontario Seniors Dental Care Program Application Through Guarantor

    You may use this application form to apply for the Ontario Seniors Dental Care Program if you do not have a valid Social Insurance Number (SIN) and/or if you have not filed your Personal Tax Return(s) with Canada Revenue Agency (CRA) for the most recent tax year. If you have a spouse (married or common law partner) who would also like to apply for the Program, they must complete their own application form.
  • 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.
  • 014-0406-67
    Authorizer Agreement with the Assistive Devices Program

    The Ministry of Health and Long-Term Care's Assistive Devices Program provides customer centered support and funding to Ontario residents who have long-term physical disabilities to provide access to personalized assistive devices appropriate for the individual's basic needs. To accomplish this goal the ADP must establish relationships with health professionals in order to ensure that ADP clients are assessed for cost-effective devices that best suit their needs.
  • 5127
    Ontario Seniors Dental Care Program. Authorizing or Cancelling a Representative

    You may use this form to authorize the program administrator of the Ontario Seniors Dental Care Program to deal with another person (such as your spouse or common-law partner, other family member, friend, or accountant) as your representative for program matters. The same form can be used to cancel a previously-made authorization.
  • 014-4853-44
    Reinstating Access to Information in the Ontario Laboratories Information System (OLIS)

    Complete this form if you wish to have the Ministry of Health and Long-Term Care reinstate your laboratory test information in the Ontario Laboratories Information System (OLIS) after your lab test has been completed.