347 Forms found for 006-FORM-L

Ministries: Ministry of Health

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  • 014-4900-85
    Physician Affiliation Authorization and Declaration of Professional Standing for ICHSCs

    The form is used to confirm a physician's qualifications to provide the requested services prior to processing a request to affiliate to a particular ICHSC. The licensee must ensure that the physician has been affiliated to the centre before they begin to provide licensed services.
  • 014-4574-64
    Vaccine Cold Chain Maintenance Inspection Report

    Used by public health units when conducting cold chain maintenance inspections in premises that store publicly funded vaccines.
  • 014-2045-67
    Release of Information About Previous Funding

    Written consent to release information enables the Assistive Devices Program to provide a history of previously funded equipment/supplies to a client and/or third party as specified.
  • 014-4777-87
    Request for Zavesca® - Niemann Pick Type C (NPC)

    To facilitate prescribers making reimbursement claims for treatment of Niemann Pick Type C (NIPC).
  • 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.
  • 014-4603-82
    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.
  • on00536
    Low-Volume Claim Submission Claim File Generator

    The "Low-Volume Claim Submission Claim File Generator" is a tool that allows registered Health Care Professionals/Registered Third-Party Billing Agencies (RTPBAs) to generate a claim file that can be securely submitted to the ministry electronically for the purpose of payment.