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014-4853-44
Reinstating Access to Information in the Ontario Laboratories Information System (OLIS)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.on00421
Real-time Continuous Glucose Monitor RenewalUsed to renew funding for rtCGM014-4519-45
Do Not Resuscitate Confirmation FormUsed by Health Care Facility Staff and Regulated Health Care Providers. Submit completed order request form (available at https://forms.mgcs.gov.on.ca/en/dataset/014-0350-93) to OSSDistribution@ontario.ca.014-4807-69
Application for Reduction in Long-Term Care Home Basic Accommodation - Schedule C: Continuation of Previous Dependant DeductionTo be used by residents of LTC homes who would like to apply for a reduction in the amount of their basic accommodation fees. This schedule should be used with one of the four main forms. An applicant should use this schedule if their LTC home has notified them that they are eligible for a “Continuation of Previous Dependant Deduction”.0327-88
Application for Northern Health Travel GrantUsed to apply for financial travel assistance by Northern Ontario residents who must travel long distances to access medical specialist services.014-4891-84
Request for Disclosure of Personal Claims History Information to a Third PartyForm authorizes the ministry to disclose an individual's personal claims history information directly to a third party.014-4890-84
Request for Access to Personal Claims History (PCH) Information by Individual or Individual's Substitute Decision MakerReceive information required to process Personal Claims History information requests from individuals or individual's substitute decision makers.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 ActNotice to the Board of the Need to Schedule a Mandatory Review of a Patient's Involuntary Status under Subsection 39(4) of the Act014-4578-64
Laboratory Services Notification (LSN)The Laboratory Services Notification (LSN) form is to be used by small drinking water system owners/operators to notify the local public health unit in writing as to which licensed laboratories will test drinking water samples for their small drinking water systems.014-4747-84
Application for IHP Claims Submission and Remittance Advice in Machine Readable Input (MRI)IHPs requesting approval to submit their claims in MRI formaton00328
Review of Emergency Admission to Secure Treatment ProgramThis 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.on00536
Low-Volume Claim Submission Claim File GeneratorThe "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.on00817
Northern Health Travel Grant Application Online formOnline application form used to apply for financial travel assistance by Northern Ontario residents who must travel long distances to access medical specialist services.on00323
Application for Funding Real-Time Continuous Glucose Monitoring System (rtCGM)Used to apply for Funding Continuous Glucose Monitors (CGM) Supplies3977-84
Health Care Provider Claim - Diagnostic and Treatment ServicesForm created with public health. Eligible uninsured patients diagnosed/treated for TB, physicians submit form to get paid014-1948-95
Application for Direct Bank Payment - ADPUsed by clients/vendors to receive remuneration by direct deposit versus cheque.014-4297-82
Health Card RenewalForm is generated by client communication system to have people come in to renew photo health card014-5056-87
Information Available to Health Care Providers through the Digital Health Drug Repository“The Digital Health Drug Repository (DHDR) Reference Guide may be used by health care providers to understand the inclusions and limitations of the information available through the DHDR.”014-4860-84
Vendor Application for Conformance Testing-Acceptable Use PolicyForm outlines the Conformance Testing-Acceptable Use Policy and is part of agreement between ministry and vendor who must successfully pass the conformance testing.
