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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.014-4721-84
IHP Electronic Data Transfer (EDT) Undertaking and Acknowledgement for Nurse Practitioners (NP)Form used as part of EDT registration package for IHPs014-4573-84
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 clinics014-4752-84
Undertaking by Interdisciplinary Health Providers (IHP) for Participation in Machine Readable Input (MRI)Form that Interdisciplinary Health Providers will complete and sign agreeing to conform to ministry's technical specifications for claims submission in MRI014-7158-84
In-Patient Standard Ward Costsform used for inpatients to Ontario hospitals who are here visiting from other provinces014-2404-84
Claims Flagged for Manual Reviewform submitted with claims to provide additional information regarding particular claimon00010
Ontario Autism Program Interim One-Time Funding - Independent Youth ApplicationIndependent youths registered in the Ontario Autism Program can use this form to apply for Interim One-Time Funding. Before you apply: please check if you are eligible for Interim One-Time Funding: https://www.ontario.ca/page/ontario-autism-program-interim-one-time-funding#section-1on00008
Ontario Autism Program Interim One-Time Funding - Primary Caregiver ApplicationPrimary Caregivers of children registered in the Ontario Autism Program can use this form to apply for Interim One-Time Funding. Before you apply: please check if your child is eligible for Interim One-Time Funding: https://www.ontario.ca/page/ontario-autism-program-interim-one-time-funding#section-1on00089
Access or Correction RequestYou can submit a request if you wish to: • access general records held by institutions (for example, Ontario government ministries, colleges, universities, agencies, municipalities) • request your own personal information • correct your personal information • access another individual’s personal information (with appropriate authorization or consent of the individual)on00470
Contravention - Payment FormPlease use this form if you have received an order or notice under one of the following pieces of legislation and are paying the amount of your order or notice, or you are applying for a review. • Employment Standards Act, 2000 • Employment Protection for Foreign Nationals Act, 2009on00314
Request for Prior Approval for Full Payment of Insured Out-of-Country (OOC) Health ServicesThis form is meant to be submitted by a practicing Ontario physician on behalf of their patients to request consideration of funding for out-of-country health services. Along with the completed application form, submissions must also include relevant medical documentation.014-3889-22
Clinician Aid A - Patient Request for Medical Assistance in DyingThe use of this aid is voluntary. It is being provided to assist you in making a written request for medical assistance in dying that complies with the legal requirements. Once you complete this request, you should provide it to your doctor or nurse practitioner. The completed aid may be included in your medical records and may be used by your doctor or nurse practitioner to provide health care to you.006-3242
Application for a Licence or Renewal of a Licence to Place Children for AdoptionThis is the application for a licence or renewal of a licence to place children for adoption issued by a Director under the Child, Youth and Family Services Act, 2017 (this person is generally the Coordinator of the ministry's Private and International Adoption Unit).on00284
Application for a Licence to Sell Livestock Medicines under the Animal Health Act, 2009 and (O. Reg. 584/20) (Licences to Sell Livestock Medicines Regulation)A licence is required to sell livestock medicines to owners of livestock or to another person acting on the owner's behalf, for the treatment of the owner's livestock under the Animal Health Act, 2009 and the Licences to Sell Livestock Medicines Regulation.
