Form completed to request exemption, i.e., no photo to appear on photo health card

form completed to obtain approval for dental procedures to be carried out in hospital and covered by OHIP

Form used by physicians to register with group

Form completed by provider authorizing payment to go to group

Form is generated by client communication system to have people come in to renew photo health card

form used for out-patient services incurred by visitors from another province

form sent to other provinces for reimbursement of inpatient claims paid (reciprocal)

The Application Form collects information from applicants regarding their contact information, medical practice and education history.

Application for a Licence to Establish or Maintain and Operate a Nursing Home

Used by primary care groups who have opted for group enrolment and consent and is only for changing the designated physician of individual patients.

To register ESRD patients for Special Drug Program for provision of Eythropoietins.

Application for reimbursement of cost due to use of Visudyne

The Grow Your Own Nurse Practitioner Initiative Application is the application health care organizations must complete to request participation in the Grow Your Own Nurse Practitioner Initiative.

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.

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 do not have a Notice of Assessment.

Provider/hospital applies for Interactive Voice Response to verify Health Card numbers via telephone

Form used by IHPs to set up direct bank deposit

form placed on top of bundles of primary care forms, to submit to ministry for processing.

Form submitted to ministry to obtain Health Number of patient when not available

he purpose of this form is to collect necessary information to obtain authorized consent and assure identity, under the Freedom of Information and Protection of Privacy Act (FIPPA), for application of services delivered by the Ministry of Health on your behalf (or for a “Health Care Group” in which you are a registered member), including: • Application for an OHIP Billing Number • Changes to Health Care Group Registration Information