Forms - Central Forms Repository (CFR)

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 schedule should be used with one of the four main forms. An applicant should use this schedule if their LTC home has notified them that they are eligible for a “Continuation of Previous Dependant Deduction”.

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014-2976-04
Form C - Application to the Board to Appoint a Representative under Subsection 33(2), 51(2) or 66(2) of the Health Care Consent Act.

PDF

014-3891-22
Clinician Aid C - (Secondary) "Medical Practitioner" or "Nurse Practitioner" Medical Assistance in Dying Aid

Complete this voluntary aid (Clinician Aid C) if you have been asked by a “Medical Practitioner” or “Nurse Practitioner” to provide a written opinion confirming that the Patient meets the eligibility criteria to receive medical assistance in dying. You should also include the completed aid in the patient's medical records.

PDF

014-4792-67
Application for Funding Ventilator Equipment and Supplies

Used to apply for Funding for Ventilator Equipment and Supplies

PDF

014-4793-67
Application for Funding - Respiratory Equipment & Supplies

Used to apply for Funding for Respiratory Equipment & Supplies

PDF

on00536
Low-Volume Claim Submission Claim File Generator

The "Low-Volume Claim Submission Claim File Generator" is a tool that allows registered Health Care Professionals/Registered Third-Party Billing Agencies (RTPBAs) to generate a claim file that can be securely submitted to the ministry electronically for the purpose of payment.

PDF

317 Forms found for FLR-15C-E

014-1088-41 Form 33 - Notice to Patient under Subsection 59(1) of the Act and under Clause 15(1) (a) and 15.1 (a) of Regulation 741

014-0225-47 Funding Enrollment for E.S.R.D. Patients

014-6435-41 Form 15 - Statement by Attending Physician under Subsection 35(6) of the Act

014-4777-87 Request for Zavesca® - Niemann Pick Type C (NPC)

014-3589-22 Application for Ontario Hepatitis C Assistance Plan (OHCAP) – Physician Form

014-3588-22 Application for Ontario Hepatitis C Assistance Plan (OHCAP) - Applicant Form

014-3701-22 Application for Ontario Hepatitis C Assistance Plan (OHCAP) – Applicant Form for Estates

on00009 Ontario Hepatitis C Assistance Plan (OHCAP) - Appointment of a Designated Representative

014-1787-41 Form 42 - Notice to Person under Subsection 38.1 of the Act of Application for Psychiatric Assessment under Section 15 or an Order under Section 32 of the Act

014-1065-41 Form 25 - Application to the Board to Review the Status of an Informal Patient who is a Child between 12 and 15 Years of Age under Subsection 13(1) of the Act

014-1067-41 Form 27 - Notice by Officer- in- Charge to a Child who is between 12 and 15 Years of Age, who is an Informal Patient under Subsection 38(6) of the Act

014-1066-41 Form 26 - Notice to the Board of the Need to Schedule a Mandatory Review of the Status of an Informal Patient who is a Child between 12 and 15 Years of Age under Subsection 13(2) of the Act

014-2978-04 Form E - Application to the Board for Permission to Depart from Wishes under Subsection 36(1), 53(1) or 68(1) of the Health Care Consent Act.

014-3700-22 Application for Ontario Hepatitis C Assistance Plan – (OHCAP) - Physician Form for Estate Applications

014-4807-69 Application for Reduction in Long-Term Care Home Basic Accommodation - Schedule C: Continuation of Previous Dependant Deduction

014-2976-04 Form C - Application to the Board to Appoint a Representative under Subsection 33(2), 51(2) or 66(2) of the Health Care Consent Act.

014-3891-22 Clinician Aid C - (Secondary) "Medical Practitioner" or "Nurse Practitioner" Medical Assistance in Dying Aid

014-4792-67 Application for Funding Ventilator Equipment and Supplies

014-4793-67 Application for Funding - Respiratory Equipment & Supplies

on00536 Low-Volume Claim Submission Claim File Generator

014-1088-41
Form 33 - Notice to Patient under Subsection 59(1) of the Act and under Clause 15(1) (a) and 15.1 (a) of Regulation 741

014-0225-47
Funding Enrollment for E.S.R.D. Patients

014-6435-41
Form 15 - Statement by Attending Physician under Subsection 35(6) of the Act

014-4777-87
Request for Zavesca® - Niemann Pick Type C (NPC)

014-3589-22
Application for Ontario Hepatitis C Assistance Plan (OHCAP) – Physician Form

014-3588-22
Application for Ontario Hepatitis C Assistance Plan (OHCAP) - Applicant Form

014-3701-22
Application for Ontario Hepatitis C Assistance Plan (OHCAP) – Applicant Form for Estates

on00009
Ontario Hepatitis C Assistance Plan (OHCAP) - Appointment of a Designated Representative

014-1787-41
Form 42 - Notice to Person under Subsection 38.1 of the Act of Application for Psychiatric Assessment under Section 15 or an Order under Section 32 of the Act

014-1065-41
Form 25 - Application to the Board to Review the Status of an Informal Patient who is a Child between 12 and 15 Years of Age under Subsection 13(1) of the Act

014-1067-41
Form 27 - Notice by Officer- in- Charge to a Child who is between 12 and 15 Years of Age, who is an Informal Patient under Subsection 38(6) of the Act

014-1066-41
Form 26 - Notice to the Board of the Need to Schedule a Mandatory Review of the Status of an Informal Patient who is a Child between 12 and 15 Years of Age under Subsection 13(2) of the Act

014-2978-04
Form E - Application to the Board for Permission to Depart from Wishes under Subsection 36(1), 53(1) or 68(1) of the Health Care Consent Act.

014-3700-22
Application for Ontario Hepatitis C Assistance Plan – (OHCAP) - Physician Form for Estate Applications

014-4807-69
Application for Reduction in Long-Term Care Home Basic Accommodation - Schedule C: Continuation of Previous Dependant Deduction

014-2976-04
Form C - Application to the Board to Appoint a Representative under Subsection 33(2), 51(2) or 66(2) of the Health Care Consent Act.

014-3891-22
Clinician Aid C - (Secondary) "Medical Practitioner" or "Nurse Practitioner" Medical Assistance in Dying Aid

014-4792-67
Application for Funding Ventilator Equipment and Supplies

014-4793-67
Application for Funding - Respiratory Equipment & Supplies

on00536
Low-Volume Claim Submission Claim File Generator