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5041-77
Request for Prior Approval for Funding of Sex-Reassignment SurgeryForm to be completed by providers on behalf of patients seeking prior approval for insured sex-reassignment surgery.014-0951-84
Out-of-Province/Out-of-Country Claim SubmissionForm used so patient can submit out of country medical receipts014-4919-57
Request for Rights Advice Community Treatment Order (CTO)Used by Mental Health Professional to request Rights Advice for both patient and SDM (if indicated). Form completed when Community Treatment Plan (CTP) and Form 49 are issued by physician. Form, CTP and Form 49 faxed to PPAO.014-0918-84
Remittance Advice InquiryForm used by physicians to make inquiries regarding payment details on Remittance Advice014-5056-87
Information Available to Health Care Providers through the Digital Health Drug Repository“The Digital Health Drug Repository (DHDR) Reference Guide may be used by health care providers to understand the inclusions and limitations of the information available through the DHDR.”014-4860-84
Vendor Application for Conformance Testing-Acceptable Use PolicyForm outlines the Conformance Testing-Acceptable Use Policy and is part of agreement between ministry and vendor who must successfully pass the conformance testing.014-4744-84
IHP Application for Direct Bank PaymentForm used by IHPs to set up direct bank deposit014-2743-84
Request for Approval of Payment for Proposed Dental Proceduresform completed to obtain approval for dental procedures to be carried out in hospital and covered by OHIP014-4455-64
Universal Influenza Immunization Program Pharmacy FormUniversal Influenza Immunization Program Pharmacy Form for influenza immunization clinics that are eligible for reimbursement through the Universal Influenza Immunization Program.014-2861-69
Consent to Inspect Assets Form 2Used to determine whether a person who is eligible for homemaking and nurses services is required to pay the fees prescribed for the services.014-4590-64
Response to Adverse Drinking Water Quality Incidents - ResolveThis form is completed by Public Health Boards when MOH site is down.014-4721-84
IHP Electronic Data Transfer (EDT) Undertaking and Acknowledgement for Nurse Practitioners (NP)Form used as part of EDT registration package for IHPson00315
Consent Form for the Inherited Metabolic Diseases (IMD) ProgramConsent Form for the Inherited Metabolic Diseases (IMD) Program014-4573-84
Primary Health Care Request to Change Designated Physician - Group EnrolmentUsed by primary care groups who have opted for group enrolment and consent and is only for changing the designated physician of individual patients.014-4340-84
Primary Care - Time and Location of After Hours ServicesForm used to record hours of physicians in after hours clinics4975-47
MedsCheck Patient Acknowledgement of Professional Pharmacy ServiceThe ministry is introducing an annual process for patient acknowledgement of professional pharmacy services. This is facilitated with the use of a mandatory form and when completed by the patient confirms the patient's understanding of MedsCheck.
