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
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
The Application Form collects information from applicants regarding their contact information, medical practice and education history.
Physicians complete form to indicate their preference on how malpractice reimbursement will be sent to them.
Physicians complete form to apply for OHIP billing number and/or specialty billing number.
Under Interprovincial agreement, for travel within Canada, patients/physicians submit form to get reimbursed by applicable health plan.
For faster decisions, prescribers can use the SADIE online portal to submit requests to the Exceptional Access Program (EAP). Sign in through GO Secure (
https://www.ebse.health.gov.on.ca) and select SADIE from the services drop-down menu. Visit the SADIE website for more information:
http://www.ontario.ca/sadie. Alternatively, this form can be used for submitting requests to the EAP by fax.
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.
The Grow Your Own Nurse Practitioner Initiative Application is the application health care organizations must complete to request participation in the Grow Your Own Nurse Practitioner Initiative.
PPLBP forms gather necessary information to help determine the applicant eligibility for the program.
Used to apply for financial travel assistance by Northern Ontario residents who must travel long distances to access medical specialist services.
This form is to be used by fee-for-service dental providers to enroll clients into the Emergency and Essential Services Stream of Healthy Smiles Ontario.
Form authorizes the ministry to disclose an individual's personal claims history information directly to a third party.
Receive information required to process Personal Claims History information requests from individuals or individual's substitute decision makers.
Receive information required to prove consent provided by individuals or individual's decision makers in order to process Personal Claims History information requests from Third Parties.
Provider/hospital applies for Interactive Voice Response to verify Health Card numbers via telephone
