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014-0406-67
Authorizer Agreement with the Assistive Devices ProgramThe 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 must establish relationships with health professionals in order to ensure that ADP clients are assessed for cost-effective devices that best suit their needs.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.014-3134-84
Application For IVR ParticipationProvider/hospital applies for Interactive Voice Response to verify Health Card numbers via telephone014-4747-84
Application for IHP Claims Submission and Remittance Advice in Machine Readable Input (MRI)IHPs requesting approval to submit their claims in MRI format014-5036-64
Healthy Smiles Ontario - Ontario Works First Nations Verification FormFirst Nations clients receiving Ontario Works will fill out this form and mail it to the HSO Program Administrator in order to enroll in the Healthy Smiles Ontario Program.014-4908-87
Initial Request for Compassionate Review PolicyTo help physicians to submit requests for drug funding for their ODB-eligible patients under the Compassionate Review Policy.3977-84
Health Care Provider Claim - Diagnostic and Treatment ServicesForm created with public health. Eligible uninsured patients diagnosed/treated for TB, physicians submit form to get paid014-4919-57
Request for Rights Advice Community Treatment Order (CTO)Used by Mental Health Professional to request Rights Advice for both patient and SDM (if indicated). Form completed when Community Treatment Plan (CTP) and Form 49 are issued by physician. Form, CTP and Form 49 faxed to PPAO.014-2743-84
Request for Approval of Payment for Proposed Dental Proceduresform completed to obtain approval for dental procedures to be carried out in hospital and covered by OHIP014-2861-69
Consent to Inspect Assets Form 2Used to determine whether a person who is eligible for homemaking and nurses services is required to pay the fees prescribed for the services.on00326
Emergency Admission to Secure Treatment ProgramThis form is completed by the person in charge of the secure treatment program once the criteria are met for the child's emergency admission to a secure treatment program.014-5048-45
AEMCA Examination ApplicationThe 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.014-4812-99
Application to Re-enter Postgraduate Medical TrainingThe Application Form collects information from applicants regarding their contact information, medical practice and education history.on00026
Healthy Smiles Ontario - Application Through GuarantorHealthy Smiles Ontario Application Through Guarantor form for the core services stream of the program. This form applies to applicants who do not have a valid SIN or have not filed taxes with the CRA, and a guarantor is required to support registration and eligibility adjudication.014-3889-84
Medical Liability Protection (MLP) Reimbursement Program Authorization/ Direct Deposit RequestPhysicians complete form to indicate their preference on how malpractice reimbursement will be sent to them.014-4953-64
Healthy Smiles Ontario - General ApplicationHealthy Smiles Ontario General Application form for the core services stream of the program. This form applies to applicants that have a valid SIN and have filed a statement of income or a tax return with the CRA.on00700
Laboratory Licensing and X-Ray Inspection Services Fees PaymentTo facilitate secure and real-time electronic payments for clinical laboratory licences and x-ray facility application fees using debit and credit cards.4611-45
Paramedic Labour Mobility ApplicationApplication 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.014-5052-45
AEMCA Examination Withdrawal and Refund ApplicationThe 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.
