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014-2862-69
Medical Certificate Form 3Application used by First Nations and the North014-4591-87
Request for Elaprase®To facilitate physician's in making an EAP request for funding/reimbursement of Elaprase for Hunter's Syndrome.014-0691-84
Request for Approval of Payment for Proposed SurgeryForm to request approval for patient to receive surgery In-Province.014-4815-69
Rate Reduction Application in Long-Term Care - Document List Required for Assessment of Resident EligibilityTo be used by residents of LTC homes who would like to apply for a reduction in the amount of their basic accommodation fees. This document guides applicants in determining which supporting documents will be required as part of their application. This document is to be used by applicants who have a Notice of Assessment.014-4816-69
Rate Reduction Application in Long-Term Care - Document List Required for Assessment of Resident without NOATo be used by residents of LTC homes who would like to apply for a reduction in the amount of their basic accommodation fees. This document guides applicants in determining which supporting documents will be required as part of their application. This document is to be used by applicants who do not have a Notice of Assessment.014-4420-84
Health Claim014-2784-87
Drug Benefit Claim Submission FormUsed by pharmacies for submitting claims014-3057-87
Nutrition ProductsUsed for obtaining authorization for nutrition products as an ODB benefit under certai circumstances014-4519-45
Do Not Resuscitate Confirmation FormUsed by Health Care Facility Staff and Regulated Health Care Providers. Submit completed order request form (available at https://forms.mgcs.gov.on.ca/en/dataset/014-0350-93) to OSSDistribution@ontario.ca.014-4749-84
IHP Electronic Data Transfer (EDT) Undertaking and AcknowledgementForm related to EDT process for IHPs014-4742-84
Application for IHP Group RegistrationForm will be used by IHPs to form a registered group045-2308-69
Profile of Long-Term Care FacilityPart of Nursing Home Inspection Kit4975-47
MedsCheck Patient Acknowledgement of Professional Pharmacy ServiceThe ministry is introducing an annual process for patient acknowledgement of professional pharmacy services. This is facilitated with the use of a mandatory form and when completed by the patient confirms the patient's understanding of MedsCheck.014-4900-85
Physician Affiliation Authorization and Declaration of Professional Standing for ICHSCsThe form is used to confirm a physician's qualifications to provide the requested services prior to processing a request to affiliate to a particular ICHSC. The licensee must ensure that the physician has been affiliated to the centre before they begin to provide licensed services.014-4769-85
Appointment & Acknowledgement of Quality Assurance AdvisorThe ICHSC Program must be notified of a change in quality assurance advisor through the submission of the Quality Assurance Advisor form which must be signed by both the centre’s quality assurance advisor and the licensee.014-5034-64
Healthy Smiles Ontario Parent Notification Form (PNF) Emergency and Essential Services Stream (EESS)This form is to be used by Public Health Units after dental screening to notify parents/guardians that their child has an emergency and/or essential dental condition(s). Parents/Guardian will complete the form and return it to the Public Health Unit to let them know that the child has initiated treatment or to attest to financial hardship and enroll into the Emergency and Essential Services Stream of Healthy Smiles Ontario.
