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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 OHIP014-1265-84
Health Number ReleaseHospitals submit form to ministry to obtain Health Number of patient when number is not available014-4652-87
Request for Myozyme®014-4323-04
Notice of Withdrawal014-3143-04
New Accused Information Sheet014-7026-65
Health Service Organization Information Sheet014-1470-41
Memorandum of Transfer – NCR Patient014-4749-84
IHP Electronic Data Transfer (EDT) Undertaking and AcknowledgementForm related to EDT process for IHPs014-4478-84
Adjustmentonline form to be available to providers and to Regional Operations staff on a permanent basis on the interneton00314
Request for Prior Approval for Full Payment of Insured Out-of-Country (OOC) Health ServicesThis form is meant to be submitted by a practicing Ontario physician on behalf of their patients to request consideration of funding for out-of-country health services. Along with the completed application form, submissions must also include relevant medical documentation.014-4406-87
Request for an Unlisted Drug Product - Exceptional Access Program (EAP)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.014-4347-84
Request for Major Eye Examinationform to be completed by those eligible for eye exams to be covered under OHIP014-4721-84
IHP Electronic Data Transfer (EDT) Undertaking and Acknowledgement for Nurse Practitioners (NP)Form used as part of EDT registration package for IHPs014-4420-84
Health Claim014-3056-64
Daily Record of Spa Operation014-1667-88
Application for Physician Locum Programs014-3759-83
Community Treatment Order (CTO) Report Logform used to provide patient with a comprehensive plan of community-based treatment or care and supervision.014-4817-69
Long-Term Care Home Support Document List - Submitting NOA that included benefit(s) that a resident is no longer receiving because they have transitioned to new benefit(s)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 document guides applicants in determining which supporting documents will be required as part of their application. This document is to be used by applicants who have a Notice of Assessment from the year when they were 64 years of age.