The information on this form is used to determine eligibility for grant assistance under the Assistive Devices Program.
Form completed by clients to record their wishes for organ/tissue donation
To facilitate prescribers making reimbursement claims for treatment of Hurler-Scheie and Hurler disease
This form is to be used for a patient who is seeking a reduction to the co-payment or for whom a reduction is sought further to the factors set out in section 10 of Reg. 552 under the Health Insurance Act.
Form to show all group locations where physician services provided
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.
Form used to change status of OHIP coverage - i.e., change of address, name, citizenship status, etc. or to cancel OHIP coverage or replacement of lost, stolen and damaged card
Form used to update/change address information of OHIP cardholders
