Forms - Central Forms Repository (CFR)

014-4807-69
Application for Reduction in Long-Term Care Home Basic Accommodation - Schedule C: Continuation of Previous Dependant Deduction

To 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”.

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014-0280-82
Change of Information

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

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014-4897-64
Statement of Conscience or Religious Belief – Immunization of School Pupils 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.

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4611-45
Paramedic Labour Mobility Application

Application and Verification forms for the Ministry of Health (MOH) Paramedic Labour Mobility Equivalency for Paramedics who hold a valid license or certification in good standing from other Canadian provinces or territories and wish to obtain equivalency in Ontario for their paramedic qualification.

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014-4387-87
Unblocking Access to Your Drug and Pharmacy Service Information

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014-4564-85
Licence Transfer Application

Transfer of ownership of Integrated Community Health Services Centre (ICHSC) licence.

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5047-87
Temporary Unblocking of Access to Drug and Pharmacy Service Information

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014-5048-45
AEMCA Examination Application

The application form is for candidates who have either successfully completed the Paramedic training program provided by an approved College or Training Institution or have been considered equivalent through the MOH Standard Paramedic Equivalency Process and wish to write to write the Ministry of Health (MOH) Advanced Emergency Medical Care Assistant (AEMCA) examination.

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014-4895-64
Statement of Medical Exemption – Immunization of School Pupils Act

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.

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0327-88
Application for Northern Health Travel Grant

Used to apply for financial travel assistance by Northern Ontario residents who must travel long distances to access medical specialist services.

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014-5052-45
AEMCA Examination Withdrawal and Refund Application

The withdrawal form is to be completed by individuals who have applied and paid to write the Ministry of Health (MOH) Advanced Emergency Medical Care Assistant (AEMCA) exam and now wish to withdraw from the exam.

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014-3384-83
Application for OHIP Billing Number for Health Professionals

Physicians complete form to apply for OHIP billing number and/or specialty billing number.

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014-5027-41
Form 53 - Application to the Board to Vary or Cancel Section 41.1 Orders of the Board under Section 39(9) of the Act

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014-2975-04
Form B - Application to the Board to Appoint a Representative under Subsection 33(1), 51(1) or 66(1) of the Health Care Consent Act.

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014-2976-04
Form C - Application to the Board to Appoint a Representative under Subsection 33(2), 51(2) or 66(2) of the Health Care Consent Act.

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014-2973-04
Form A - Application to the Board to Review a Finding of Incapacity under Subsection 32(1), 50(1) or 65(1) of the Health Care Consent Act

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014-4351-04
Form P1 - Application to the Board to Review a Determination of Incapacity under Subsection 22(3) of the Personal Health Information Protection Act

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014-4508-67
Insulin Pump Product Evaluation

Used to evaluate Insulin pumps

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014-5095-87
Consent to the Ministry of Health Collection and/or Disclosure of Personal Health Information for Ontario Drug Benefit Program Recipients

This form is available on the Ontario Drug Benefit Program Online Applications and Forms website: https://forms.ontariodrugbenefit.ca/. If you are not able to complete the form online, please contact the TDP at 416-642-3038 (Toronto area) or 1-800-575-5386 (outside Toronto) for a paper version of this form.

014-3296-64
Non-Reusable Vaccine (spoiled or expired) Return Record - Toronto Clients

Used by Toronto clients to return non-reusable vaccines (spoiled or expired) to the Ontario Government Pharmaceutical and Medical Supply Service

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329 Forms found for 016-MOL-ES-002E

014-4807-69 Application for Reduction in Long-Term Care Home Basic Accommodation - Schedule C: Continuation of Previous Dependant Deduction

014-0280-82 Change of Information

014-4897-64 Statement of Conscience or Religious Belief – Immunization of School Pupils Act

4611-45 Paramedic Labour Mobility Application

014-4387-87 Unblocking Access to Your Drug and Pharmacy Service Information

014-4564-85 Licence Transfer Application

5047-87 Temporary Unblocking of Access to Drug and Pharmacy Service Information

014-5048-45 AEMCA Examination Application

014-4895-64 Statement of Medical Exemption – Immunization of School Pupils Act

0327-88 Application for Northern Health Travel Grant

014-5052-45 AEMCA Examination Withdrawal and Refund Application

014-3384-83 Application for OHIP Billing Number for Health Professionals

014-5027-41 Form 53 - Application to the Board to Vary or Cancel Section 41.1 Orders of the Board under Section 39(9) of the Act

014-2975-04 Form B - Application to the Board to Appoint a Representative under Subsection 33(1), 51(1) or 66(1) of the Health Care Consent Act.

014-2976-04 Form C - Application to the Board to Appoint a Representative under Subsection 33(2), 51(2) or 66(2) of the Health Care Consent Act.

014-2973-04 Form A - Application to the Board to Review a Finding of Incapacity under Subsection 32(1), 50(1) or 65(1) of the Health Care Consent Act

014-4351-04 Form P1 - Application to the Board to Review a Determination of Incapacity under Subsection 22(3) of the Personal Health Information Protection Act

014-4508-67 Insulin Pump Product Evaluation

014-5095-87 Consent to the Ministry of Health Collection and/or Disclosure of Personal Health Information for Ontario Drug Benefit Program Recipients

014-3296-64 Non-Reusable Vaccine (spoiled or expired) Return Record - Toronto Clients