4 Forms found for 016-0008A

Ministries: Ministry of Health Formats: HTML

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  • 014-4431-84
    Primary Health Care Unattached Patient Declaration

    form used, in urgent cases (i.e. patient was in hospital, newborn in NICU) where patient has no family physician so can join primary group.
  • on00574
    Provider Registration/Change Request Form

    This application is to enable currently licensed health care professionals to be able to begin submitting or continue to submit claims to the Ministry of Health (the ministry) for insured services. Options include: • Register for an OHIP Billing Number • Register a Health Care Group • Authorize the ministry to make payments to a health care group on your behalf • Update address, banking, and/or group information • Register for Interactive Voice Response (IVR) • Register for the SAV Portal
  • 014-4521-84
    Application for Prior Approval for Full Payment of Insured Out-of-Country (OOC) & Out-of-Province (OOP) Laboratory & Genetics Testing

    The OOC/OOP PA Program eForm is designed to be completed and submitted electronically for application for prior approval for full payment of insured Out-of-Country (OOC) & Out-of-Province (OOP) laboratory and genetics testing services. English and French versions can be completed online or downloaded and saved for future use.
  • 014-4442-97
    Return Authorization for Resalable Drugs and Medical Supplies

    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.