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014-4431-84
Primary Health Care Unattached Patient Declarationform used, in urgent cases (i.e. patient was in hospital, newborn in NICU) where patient has no family physician so can join primary group.014-2196-67
Application for Funding Mobility DevicesApplication for Funding Mobility Devices014-4940-87
Exceptional Access Program (EAP) Request OxyNEO (Oxycodone Hydrochloride Controlled Release) TabletsThe purpose of the e-Form is to assist physicians in the EAP drug request process by integrating all the rules/criteria into an interactive e-Form that will ensure all the necessary information is captured.014-4943-87
Exceptional Access Program (EAP) Request Lovenox (Enoxaparin Sodium) TherapyThe purpose of the e-Form is to assist physicians in the EAP drug request process by integrating all the rules/criteria into an interactive e-Form that will ensure all the necessary information is captured.014-4473e-67
Prior Testing Disclosure - Manual WheelchairThis form is used by Manufacturer's Testing Facilities to report testing of Manual Wheelchairs.014-2772-87
Special Authorization (Allergen)Used for obtaining authorization for allergen exact as an ODB benefit014-4475e-67
Prior Testing Disclosure - Ambulation AidsThis form is used by Manufacturer's Testing Facilities to report testing of Ambulation Aids014-4942-87
Exceptional Access Program (EAP) Request Innohep (Tinzaparin Sodium) TherapyThe purpose of the e-Form is to assist physicians in the EAP drug request process by integrating all the rules/criteria into an interactive e-Form that will ensure all the necessary information is captured.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.014-4891-84
Request for Disclosure of Personal Claims History Information to a Third PartyForm authorizes the ministry to disclose an individual's personal claims history information directly to a third party.014-2451-67
Application for Funding Home Oxygen TherapyTo be used for all applications for Home Oxygen Therapy funding.014-0265-82
Registration for Ontario Health CoverageForm is used to register new or returning Ontario residents or renew photo Health Card and contains instructions/information.014-5109-20
Specialty Vape Store RegistrationFor retailers that primarily sell vapour products to apply for a specialty vape store registration.014-4297-82
Health Card RenewalForm is generated by client communication system to have people come in to renew photo health card014-0918-84
Remittance Advice InquiryForm used by physicians to make inquiries regarding payment details on Remittance Adviceon00315
Consent Form for the Inherited Metabolic Diseases (IMD) ProgramConsent Form for the Inherited Metabolic Diseases (IMD) Program
