form used, in urgent cases (i.e. patient was in hospital, newborn in NICU) where patient has no family physician so can join primary group.
Complete this form if you wish to have the Ministry of Health and Long-Term Care reinstate your laboratory test information in the Ontario Laboratories Information System (OLIS) after your lab test has been completed.
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.
Used for obtaining authorization for allergen exact as an ODB benefit
Application form completed by nursing candidates to apply to Tuition Support Program for Nurses for financial incentives.
For Specialist physician & ADP registered authorizers to request funding for extraoral (facial) prostheses.
For Specialist physician & ADP registered authorizer to request funding for intraoral (mouth) prostheses.
Used by clients to apply for funding for a silicone breast prosthesis(es)
Application used by Homemaker and Nurses to request reimbursement from the Province for services provided.
The Ministry of Health and Long-Term Care's Assistive Devices Program provides customer centered support and funding to Ontario residents who have long-term physical disabilities to provide access to personalized assistive devices appropriate for the individual's basic needs. To accomplish this goal the ADP establishes contracts with vendors in order to ensure that ADP funding for clients are in accordance with Program policies.
A physician or nurse practitioner must complete a Statement of Medical Exemption for children who require a medical exemption from vaccine requirements under the Immunization of School Pupils Act.
Form used by physicians to make inquiries regarding payment details on Remittance Advice
Form used to record hours of physicians in after hours clinics
Form authorizes the ministry to disclose an individual's personal claims history information directly to a third party.
Used to apply for Funding Continuous Glucose Monitors (CGM) Supplies
The Application form collects information from employers to determine their eligibility for funding through the PA Career Start Program.
form submitted with claims to provide additional information regarding particular claim
Receive information required to process Personal Claims History information requests from individuals or individual's substitute decision makers.
