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Used by clients to request funding assistance for Insulin Pumps and Supplies for Children
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The information on this form is used to determine eligibility for grant assistance under the Assistive Devices Program.
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Form completed by clients to record their wishes for organ/tissue donation
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This form is to be used for a patient who is seeking a reduction to the co-payment or for whom a reduction is sought further to the factors set out in section 10 of Reg. 552 under the Health Insurance Act.
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Form to show all group locations where physician services provided
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The MedsCheck for Diabetes includes an Annual review that involves using the pharmacist's worksheet and providing the patient with a MedsCheck Personal Medication Record; as well as using a Diabetes Education Checklist and providing the patient with a Diabetes Education Patient Take-Home Summary.
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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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Form used to update/change address information of OHIP cardholders
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Application for Rehabilitation Assessor/Fitter/Dispenser Status
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Calculation of Chronic Care Co-Payments for use by hospital staff, patients, and families.
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Used to apply for Funding for Ocular Prostheses
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Application for services of a homemaker or a nurse
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