-
on00026
Healthy Smiles Ontario - Application Through GuarantorHealthy Smiles Ontario Application Through Guarantor form for the core services stream of the program. This form applies to applicants who do not have a valid SIN or have not filed taxes with the CRA, and a guarantor is required to support registration and eligibility adjudication.on00704
2024 Physician Assistant (PA) Career Start- CONTACT, RECRUITMENT AND FINANCIAL (CRF) FORMThe form collects contact, recruitment and financial information from applicants who have successfully recruited PA graduates.3977-84
Health Care Provider Claim - Diagnostic and Treatment ServicesForm created with public health. Eligible uninsured patients diagnosed/treated for TB, physicians submit form to get paid5041-77
Request for Prior Approval for Funding of Sex-Reassignment SurgeryForm to be completed by providers on behalf of patients seeking prior approval for insured sex-reassignment surgery.on00315
Consent Form for the Inherited Metabolic Diseases (IMD) ProgramConsent Form for the Inherited Metabolic Diseases (IMD) Programon00326
Emergency Admission to Secure Treatment ProgramThis 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.on00029
Form Y5Application to the Board to Amend the Conditions of, or Terminate the Appointment of a Representative under Subsection 305(8) or (9) of the Child, Youth and Family Services Act.4974-47
Patient Take Home SummaryPharmacists 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.4968-47
Personal Medication RecordUsing the standardized fax template, pharmacists must share the completed MedsCheck Personal Medication Record with the patient's primary prescriber. A record of the successfully transmitted fax must be kept on file at the pharmacy.on00314
Request for Prior Approval for Full Payment of Insured Out-of-Country (OOC) Health ServicesThis 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.on00520
Relocation Application (Fixed Site)Licensees of Integrated Community Health Services Centres (ICHSCs) must submit an application and obtain written approval from the Director of Integrated Community Health Services Centres prior to a centre’s relocation. For the purposes of this application, a “Fixed Site” centre is a licensed ICHSC where the Limitations and Conditions of the licence specify a single geographic location or address where specified services may be provided.on00700
Laboratory Licensing and X-Ray Inspection Services Fees PaymentTo facilitate secure and real-time electronic payments for clinical laboratory licences and x-ray facility application fees using debit and credit cards.4611-45
Paramedic Labour Mobility ApplicationApplication and Verification forms for the Ministry of Health (MOH) Paramedic Labour Mobility Equivalency for Paramedics who hold a valid license or certification in good standing from other Canadian provinces or territories and wish to obtain equivalency in Ontario for their paramedic qualification.on00703
2024 Physician Assistant (PA) Career Start Grant Application FormThe Application form collects information from employers to determine their eligibility for funding through the PA Career Start Program.56-4965
Grow Your Own Nurse Practitioner Initiative - ApplicationThe Grow Your Own Nurse Practitioner Initiative Application is the application health care organizations must complete to request participation in the Grow Your Own Nurse Practitioner Initiative.on00347
Request for Disclosure of Personal Claims History (PCH) Information to a Third Party (for High-Volume Submitters)The eForm is currently unavailable at this time. We would like to have the option to re-activate the eForm at a later date.7219-41
Form 17 - Notice to the Board of the Need to Schedule a Mandatory Review of a Patient's Involuntary Status under Subsection 39(4) of the ActNotice to the Board of the Need to Schedule a Mandatory Review of a Patient's Involuntary Status under Subsection 39(4) of the Acton00159
COVID-19 Vaccine Cold Chain Incident Exposure/Wastage ReportRecord and report COVID-19 cold chain failures by hospitals and long-term care homes to public health units and the ministry.on00028
Form P5Application 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.
