Application for services of a homemaker or a nurse

Application used by First Nations and the North

Used to determine whether a person who is eligible for homemaking and nurses services is required to pay the fees prescribed for the services.

Used for the determination of applicant's available monthly income.

To 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.

Use this form if you ordered drugs and/or medical supplies from OGPMSS and wish to return resalable drugs and/or medical supplies to OGPMSS. OGPMSS will only accept returns and provide credit for resalable drugs or supplies that meet the criteria listed on the form. OGPMSS will provide you with a Return Authorization Number within 2 business days upon receipt of a completed form.

To provide patient advocacy groups with a template for written submissions to the ministry on a drug; the form is to make sure all the appropriate information is provided.

For faster decisions, prescribers can use the SADIE online portal to submit requests to the Exceptional Access Program (EAP). Sign in through GO Secure (https://www.ebse.health.gov.on.ca) and select SADIE from the services drop-down menu. Visit the SADIE website for more information: http://www.ontario.ca/sadie. Alternatively, this form can be used for submitting requests to the EAP by fax.

To facilitate prescribers making reimbursement claims for treatment of Niemann Pick Type C (NIPC).

To facilitate physician's in making an EAP request for funding/reimbursement of Elaprase for Hunter's Syndrome.