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
Form used to update/change address information of OHIP cardholders
Application for Rehabilitation Assessor/Fitter/Dispenser Status
Calculation of Chronic Care Co-Payments for use by hospital staff, patients, and families.
Used to apply for Funding for Ocular Prostheses
Used by pharmacies for submitting claims or reversals
Application for services of a homemaker or a nurse
Used to evaluate Insulin pumps
To maintain registration of health care professionals, termed authorizers, by the Assistive Devices Program
Must be completed for every MedsCheck; pharmacists must have professional notes and/or a worksheet when conducting a MedsCheck.
Use by vendor/manufacturer to apply for equipment listing insulin pumps.
Form is generated by client communication system.
