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014-7158-84
In-Patient Standard Ward Costsform used for inpatients to Ontario hospitals who are here visiting from other provinces014-2404-84
Claims Flagged for Manual Reviewform submitted with claims to provide additional information regarding particular claim014-4723-87
Submission of Patient Evidence Patient Advocacy Groups - Registration FormTo allow patient advocacy groups to register into the database so that they provide written submissions to the ministry on a drug; the form is to make sure all the appropriate information is provided.014-4812-99
Application to Re-enter Postgraduate Medical TrainingThe Application Form collects information from applicants regarding their contact information, medical practice and education history.014-3384-83
Application for OHIP Billing Number for Health ProfessionalsPhysicians complete form to apply for OHIP billing number and/or specialty billing number.014-0000-80
Out of Province Claim for Physician ServicesUnder Interprovincial agreement, for travel within Canada, patients/physicians submit form to get reimbursed by applicable health plan.014-3750-84
Organ and Tissue Donor RegistrationForm completed by clients to record their wishes for organ/tissue donation014-3264-54
Hospital Chronic Care Co-payment FormCalculation of Chronic Care Co-Payments for use by hospital staff, patients, and families.014-4751-84
Interdisciplinary Health Provider (IHP) Nurse Practitioner (NP) Authorization for Participation in the NP Service Encounter Reporting and Tracking (SERT) InitiativeForm will be used for NPs to become affiliated with an organization and participate in the NP Service Encounter Tracking and Reporting (SERT) Initiative to receive funding from the MOHLTC014-3134-84
Application For IVR ParticipationProvider/hospital applies for Interactive Voice Response to verify Health Card numbers via telephone014-4747-84
Application for IHP Claims Submission and Remittance Advice in Machine Readable Input (MRI)IHPs requesting approval to submit their claims in MRI format014-4551-87
Application and Consent for the Inherited Metabolic Diseases (IMD) ProgramFor physicians and patients to apply for the Inherited Metabolic Disorders (IMD) Program.014-4344-64
Influenza Vaccine Order Form for the Universal Influenza Immunization ProgramEligibility Criteria for Trivalent Inactivated Influenza Vaccine.014-2352-88
Application for Rehabilitation Incentive GrantApplication form completed by rehabilitation professionals applying to Underserviced Area Program for financial incentives, in return for filling full-time vacancies in MOHLTC fully-funded positions in Northern Ontario.014-4550-88
Application for Tuition Support Program for NursesApplication form completed by nursing candidates to apply to Tuition Support Program for Nurses for financial incentives.014-4727-88
Application for Northern and Rural Recruitment and Retention InitiativeApplication for physicians to apply for HFO Northern and Rural Recruitment & Retention Program014-2203-64
Toronto Clients Requisition for Biological Supplies (for use in M postal code areas only)Used by Toronto Clients to order Biological Supplies from Ontario Government Pharmaceutical and Medical Supply Service.014-5109-20
Specialty Vape Store RegistrationFor retailers that primarily sell vapour products to apply for a specialty vape store registration.014-4574-64
Vaccine Cold Chain Maintenance Inspection ReportUsed by public health units when conducting cold chain maintenance inspections in premises that store publicly funded vaccines.
