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
Application 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.
Form to be completed by providers on behalf of patients seeking prior approval for insured sex-reassignment surgery.
Form allows providers to refer patients for assessment for the program and will be used by hospital sites to record patient eligibility.
Used by pharmacies for submitting claims or reversals
To maintain registration of health care professionals, termed authorizers, by the Assistive Devices Program
Use by vendor/manufacturer to apply for equipment listing insulin pumps.
Used by Mental Health Inpatient Unit staff to request Rights Advice. Form is completed when a physician issues a Mental Health Act form that requires the provision of Rights Advice. Fax form to the PPAO and Rights Adviser will be assigned
The MedsCheck for Diabetes includes an Annual review that involves using the pharmacist's worksheet and providing the patient with a MedsCheck Personal Medication Record; as well as using a Diabetes Education Checklist and providing the patient with a Diabetes Education Patient Take-Home Summary.
This form is to be completed by a Specialty-Service Provider who provides an OHIP-insured service to a patient who is eligible for a Northern Health Travel Grant (NHTG).
IMPORTANT: This form is to be used only for the purpose of patients looking to submit NHTG applications via the NHTG Online Form. This form must be included as an attachment and submitted via the NHTG Online Form, which you can access at the following location:
https://forms.mgcs.gov.on.ca/dataset/on00817
If you wish to submit by mail, please complete the NHTG Application available on the ministry website:
https://forms.mgcs.gov.on.ca/dataset/0327-88
The Vendor Registration Application form is an interactive form that will be completed by an Ontario retailer or supplier of home oxygen therapy who is requesting registration with the Assistive Devices Program.
This form is used by manufacturers/distributors of mobility equipment (wheelchairs and wheeled walkers) for the purpose of making application to the Assistive Devices Program requesting approval to list their respective products on the list of approved devices.
This form is used by manufacturers/distributors of mobility equipment (wheelchairs and wheeled walkers) for the purpose of making application to the Assistive Devices Program requesting approval to list their respective products on the list of approved devices.
Application used to determine eligibility for funding by ADP for Hearing Devices.
Confirmation that an offer and acceptance of employment has been made for nursing services
