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.
Used to apply for Funding Continuous Glucose Monitors (CGM) Supplies
This form is meant to be submitted by a practicing Ontario physician on behalf of their patients to request consideration of funding for out-of-country health services. Along with the completed application form, submissions must also include relevant medical documentation.
The Application form collects information from employers to determine their eligibility for funding through the PA Career Start Program.
Used to request a change in vendor for an approved Assistive Devices Program claim
The eForm is currently unavailable at this time. We would like to have the option to re-activate the eForm at a later date.
Used to renew funding for rtCGM
Emergency admission of a child to a secure treatment program.
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.
The use of this aid is voluntary. It is being provided to assist you in maintaining records for medical assistance in dying. Please use this aid if you are a “Medical Practitioner” or “Nurse Practitioner” and a patient is requesting a Waiver of Final Consent. The Waiver of Final Consent is ONLY applicable for individuals whose natural death is reasonably foreseeable (RFND).
This form is an order completed by the Chair of the Child and Family Services Review Board either releasing the child from the secure treatment program or denying the application.
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.
he purpose of this form is to collect necessary information to obtain authorized consent and assure identity, under the Freedom of Information and Protection of Privacy Act (FIPPA), for application of services delivered by the Ministry of Health on your behalf (or for a “Health Care Group” in which you are a registered member), including:
• Application for an OHIP Billing Number
• Changes to Health Care Group Registration Information
Form created with public health. Eligible uninsured patients diagnosed/treated for TB, physicians submit form to get paid
Form to be completed by providers on behalf of patients seeking prior approval for insured sex-reassignment surgery.
This form is completed by the person in charge of the secure treatment program once the criteria are met for the child's emergency admission to a secure treatment program.
Pharmacists may provide patients with a MedsCheck Patient Take-Home Summary that is intended to further engage patients in identifying ways to build added awareness in their drug therapy and help to identify therapy-related goals.
