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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.014-4807-69
Application for Reduction in Long-Term Care Home Basic Accommodation - Schedule C: Continuation of Previous Dependant DeductionTo 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”.014-0350-93
Forms Order RequestUsed by Ministry clients to order forms from OSS Distribution.014-5063-67
Addendum for Ventilator Equipment and Supplies Application FormAddendum for Ventilator Equipment and Supplies Application045-4806-69
Application for Reduction in Long-Term Care Home Basic Accommodation - Schedule B: Child DependantTo 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 they would like to request a deduction to support an eligible child living in the community.014-4347-84
Request for Major Eye Examinationform to be completed by those eligible for eye exams to be covered under OHIP014-4367-84
Primary Health Care New Patient Declarationform used so that new patient to primary health group can join that group due to reasons on form014-4750-84
Application for IHP GONet Electronic Data Transfer (EDT) ServiceIHPs apply to submit claim information via EDT014-4832-84
Primary Health Care Enrolment Material Order FormPhysicians utilise form to order Primary Health Care select forms/materials from vendor.014-4500-69
Determination of Available Monthly Income Form 4Used for the determination of applicant's available monthly income.014-4421-84
Reciprocal ClaimClaim card used by physicians to receive reimbursement for reciprocal claims
