This application is to enable currently licensed health care professionals to be able to begin submitting or continue to submit claims to the Ministry of Health (the ministry) for insured services. Options include:
• Register for an OHIP Billing Number
• Register a Health Care Group
• Authorize the ministry to make payments to a health care group on your behalf
• Update address, banking, and/or group information
• Register for Interactive Voice Response (IVR)
• Register for the SAV Portal
This form is available on the Ontario Drug Benefit Program Online Applications and Forms website :
https://forms.ontariodrugbenefit.ca/.
If you are not able to complete the form online, please contact the TDP at 416-642-3038 (Toronto area) or 1-800-575-5386 (outside Toronto) for a paper version of this form.
Receive information required to prove consent provided by individuals or individual's decision makers in order to process Personal Claims History information requests from Third Parties.
Record and report COVID-19 cold chain failures by hospitals and long-term care homes to public health units and the ministry.
The use of this aid is voluntary. It is being provided to assist you in maintaining records of requests for medical assistance in dying. Please use this aid if you are a “Medical Practitioner” or “Nurse Practitioner” and a patient is requesting medical assistance in dying and it is your intention to provide medical assistance in dying to the patient. You should also include the completed aid in the patient's medical records.
This form is to be used by fee-for-service dental providers to enroll clients into the Emergency and Essential Services Stream of Healthy Smiles Ontario.
The Seniors Co-Payment Program Application is available on the Ontario Drug Benefit Program Online Applications and Forms website:
https://forms.ontariodrugbenefit.ca/.
If you are not able to complete the form online, please contact the SCP at 416-503-4586 (Toronto area) or 1-888-405-0405 (outside Toronto) for a paper version of this form.
Court proceeding and the Information to support a warrant to apprehend and return a child who has been admitted to a secure treatment program.
The form is used to confirm a physician's qualifications to provide the requested services prior to processing a request to affiliate to a particular ICHSC. The licensee must ensure that the physician has been affiliated to the centre before they begin to provide licensed services.
This form is to be used by Public Health Units after dental screening to notify parents/guardians that their child has an emergency and/or essential dental condition(s). Parents/Guardian will complete the form and return it to the Public Health Unit to let them know that the child has initiated treatment or to attest to financial hardship and enroll into the Emergency and Essential Services Stream of Healthy Smiles Ontario.
This form is an order completed by the Chair of the Child and Family Services Review Board either releasing the child from the secure treatment program or denying the application.
This form is available on the Ontario Drug Benefit Program Online Applications and Forms website:
https://forms.ontariodrugbenefit.ca/.
If you are not able to complete the form online, please contact the TDP at 416-642-3038 (Toronto area) or 1-800-575-5386 (outside Toronto) for a paper version of this form.
The ICHSC Program must be notified of a change in quality assurance advisor through the submission of the Quality Assurance Advisor form which must be signed by both the centre’s quality assurance advisor and the licensee.
The Service Description Schedule is part of the Transfer Payment Agreement between His Majesty the King in right of Ontario as represented by the Minister of Health (“the Province”) and the Transfer Payment Recipient. The Transfer Payment Recipient will deliver the programs and services in accordance with the requirements as outlined in this Service Description Schedule document in addition to all conditions and requirements within the Transfer Payment Agreement.
The OOC/OOP PA Program eForm is designed to be completed and submitted electronically for application for prior approval for full payment of insured Out-of-Country (OOC) & Out-of-Province (OOP) laboratory and genetics testing services. English and French versions can be completed online or downloaded and saved for future use.
Certificate of Death – Form 1 to be completed by an attending physician or registered nurse in the extended class pursuant to s. 17(2)(a) of Reg. 965 – Hospital Management made under the Public Hospitals Act.
Used to renew funding for home oxygen therapy.
Notice of Transfer from a School - Immunization of School Pupils Act
