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014-0864-84
Authorization for Group PaymentForm completed by provider authorizing payment to go to group014-9998-82
Ontario Health Insurance Plan (OHIP) Document ListThis is accompaniment to Registration for OHIP & Change of Information forms. Lists acceptable ID documents when applying for Ontario health coverage.014-4752-84
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 MRI014-2404-84
Claims Flagged for Manual Reviewform submitted with claims to provide additional information regarding particular claim014-4316-84
Patient Enrolment Batch Headerform placed on top of bundles of primary care forms, to submit to ministry for processing.014-4746-84
Interdisciplinary Health Provider (IHP) Health Number ReleaseForm submitted to ministry to obtain Health Number of patient when not available014-4823-67
Application for Funding Pressure Modification DevicesUsed to apply for Funding for Pressure Modification Devices014-4793-67
Application for Funding - Respiratory Equipment & SuppliesUsed to apply for Funding for Respiratory Equipment & Supplies014-3183-67
Application for Funding Limb ProsthesesUsed by Amputee Team, registered with ADP to request funding for conventional upper/lower limb prosthees.014-0022-84
OHIP Group Registration for Health Care ProfessionalsForm used by physicians to register with group014-7521-84
Out of Province Out-patient Servicesform used for out-patient services incurred by visitors from another province014-1668-69
Application for a Licence to Establish or Maintain and Operate a Nursing HomeApplication for a Licence to Establish or Maintain and Operate a Nursing Home014-4521-84
Application for Prior Approval for Full Payment of Insured Out-of-Country (OOC) & Out-of-Province (OOP) Laboratory & Genetics TestingThe 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.014-3384-83
Application for OHIP Billing Number for Health ProfessionalsPhysicians complete form to apply for OHIP billing number and/or specialty billing number.014-4896-64
Notice of Transfer from a School - Immunization of School Pupils ActNotice of Transfer from a School - Immunization of School Pupils Act014-3759-83
Community Treatment Order (CTO) Report Logform used to provide patient with a comprehensive plan of community-based treatment or care and supervision.014-1429-67
Application for Funding for Insulin Syringes for SeniorsUsed by senior clients, 65 years and older, who are on daily insulin injections to apply for funding for syringes.
