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
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.
Used to apply for Funding for Enteral Feeding Pump and Supplies
Form created with public health. Eligible uninsured patients diagnosed/treated for TB, physicians submit form to get paid
Application form completed by nursing candidates to apply to Tuition Support Program for Nurses for financial incentives.
Application for physicians to apply for HFO Northern and Rural Recruitment & Retention Program
Form to be completed by providers on behalf of patients seeking prior approval for insured sex-reassignment surgery.
Form used so patient can submit out of country medical receipts
“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.”
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.
Form used by IHPs to set up direct bank deposit
This form is to be used for a patient who is seeking a reduction to the co-payment or for whom a reduction is sought further to the factors set out in section 10 of Reg. 552 under the Health Insurance Act.
Used by primary care groups who have opted for group enrolment and consent and is only for changing the designated physician of individual patients.
This form is completed by the person in charge of the secure treatment program once the criteria are met for the child's emergency admission to a secure treatment program.
form used so physicians can have direct deposit of payment of claims
