Used by Mental Health Professional to request Rights Advice for both patient and SDM (if indicated). Form completed when Community Treatment Plan (CTP) and Form 49 are issued by physician. Form, CTP and Form 49 faxed to PPAO.
Universal Influenza Immunization Program Reimbursement Form for influenza immunization clinics that are eligible for reimbursement through the Universal Influenza Immunization Program.
Universal Influenza Immunization Program Pharmacy Form for influenza immunization clinics that are eligible for reimbursement through the Universal Influenza Immunization Program.
The Vendor Registration Application form is an interactive form that will be completed by an Ontario retailer or supplier of assistive devices who is requesting registration with the Assistive Devices Program.
Calculation of Chronic Care Co-Payments for use by hospital staff, patients, and families.
Certificate of Death – Form 1 to be completed by an attending physician or registered nurse in the extended class pursuant to s. 17(2)(a) of Reg. 965 – Hospital Management made under the Public Hospitals Act.
The Notice of Adverse Test Results and Issue Resolution form is to be used by licensed laboratories and owners/operators of small drinking water systems to support required written notifications pertaining to small drinking water system adverse water quality incidents (AWQI).
Complete this form if you wish to have the Ministry of Health and Long-Term Care restrict access to your laboratory test information in the Ontario Laboratories Information System (OLIS) after your lab test has been completed.
The Laboratory Services Notification (LSN) form is to be used by small drinking water system owners/operators to notify the local public health unit in writing as to which licensed laboratories will test drinking water samples for their small drinking water systems.
A parent must complete a Statement of Conscience or Religious Belief and have it witnessed by a commissioner for taking affidavits if they wish to obtain a non-medical exemption for their child from vaccine requirements under the Immunization of School Pupils Act.
The purpose of the e-Form is to assist physicians in the EAP drug request process by integrating all the rules/criteria into an interactive e-Form that will ensure all the necessary information is captured.
A physician or nurse practitioner must complete a Statement of Medical Exemption for children who require a medical exemption from vaccine requirements under the Immunization of School Pupils Act.
The withdrawal form is to be completed by individuals who have applied and paid to write the Ministry of Health (MOH) Advanced Emergency Medical Care Assistant (AEMCA) exam and now wish to withdraw from the exam.
Used by Toronto clients to return non-reusable vaccines (spoiled or expired) to the Ontario Government Pharmaceutical and Medical Supply Service
Written consent to release information enables the Assistive Devices Program to provide a history of previously funded equipment/supplies to a client and/or third party as specified.
