he purpose of this form is to collect necessary information to obtain authorized consent and assure identity, under the Freedom of Information and Protection of Privacy Act (FIPPA), for application of services delivered by the Ministry of Health on your behalf (or for a “Health Care Group” in which you are a registered member), including:
• Application for an OHIP Billing Number
• Changes to Health Care Group Registration Information
Provider/hospital applies for Interactive Voice Response to verify Health Card numbers via telephone
This application is to enable currently licensed health care professionals to be able to begin submitting or continue to submit claims to the Ministry of Health (the ministry) for insured services. Options include:
• Register for an OHIP Billing Number
• Register a Health Care Group
• Authorize the ministry to make payments to a health care group on your behalf
• Update address, banking, and/or group information
• Register for Interactive Voice Response (IVR)
• Register for the SAV Portal
The form is an application for direct bank deposit for vendors registered with the Assistive Devices Program.
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.
This form is used by Manufacturer's Testing Facilities to report testing of Manual Wheelchairs.
The form collects contact, recruitment and financial information from applicants who have successfully recruited PA graduates.
Notice of Transfer from a School - Immunization of School Pupils Act
Complete this form if you wish to have the Ministry of Health and Long-Term Care restrict access to your laboratory test information in the Ontario Laboratories Information System (OLIS) after your lab test has been completed.
The Notice of Adverse Test Results and Issue Resolution form is to be used by licensed laboratories and owners/operators of small drinking water systems to support required written notifications pertaining to small drinking water system adverse water quality incidents (AWQI).
Application 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.
A parent must complete a Statement of Conscience or Religious Belief and have it witnessed by a commissioner for taking affidavits if they wish to obtain a non-medical exemption for their child from vaccine requirements under the Immunization of School Pupils Act.
Application used by Homemaker and Nurses to request reimbursement from the Province for services provided.
Used for obtaining authorization for allergen exact as an ODB benefit
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.
Hospitals submit form to ministry to obtain Health Number of patient when number is not available
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
