340 Forms found for 014-s46850E-87

Ministries: Ministry of Health

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  • on00328
    Review of Emergency Admission to Secure Treatment Program

    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.

  • 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.

  • 3977-84
    Health Care Provider Claim - Diagnostic and Treatment Services

    Form created with public health. Eligible uninsured patients diagnosed/treated for TB, physicians submit form to get paid

  • 5041-77
    Request for Prior Approval for Funding of Sex-Reassignment Surgery

    Form to be completed by providers on behalf of patients seeking prior approval for insured sex-reassignment surgery.

  • on00326
    Emergency Admission to Secure Treatment Program

    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.

  • 4974-47
    Patient Take Home Summary

    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.

  • 56-4965
    Grow Your Own Nurse Practitioner Initiative - Application

    The 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.

  • 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 Act

    Notice to the Board of the Need to Schedule a Mandatory Review of a Patient's Involuntary Status under Subsection 39(4) of the Act

  • on00594
    Form 18 (Substitute Decisions Act)

    Application to the Board for a review of a finding of incapacity to manage property under subsection 20.2(1) of the Substitute Decisions Act

  • on00313
    Request to End Household Enrolment in the Trillium Drug Program

    This 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 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.

  • 4969-47
    Diabetes Education Checklist

    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.

  • 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

  • on00460
    Physician/Nurse Practitioner Report

    Form 1 - Physician/Nurse Practitioner Report 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

  • 4976-47
    Healthcare Provider Notification of MedsCheck Services

    Using 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.

  • 4968-47
    Personal Medication Record

    Using 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.

  • 4967-47
    Pharmacists Worksheet

    Must be completed for every MedsCheck; pharmacists must have professional notes and/or a worksheet when conducting a MedsCheck.

  • 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.