-
014-1948-95
Application for Direct Bank Payment - ADPUsed by clients/vendors to receive remuneration by direct deposit versus cheque.014-4846-87
Request for Aldurazyme®To facilitate prescribers making reimbursement claims for treatment of Hurler-Scheie and Hurler disease014-3266-54
Application for Reduction of Assessed Co-payment FeesThis form is to be used for a patient who is seeking a reduction to the co-payment or for whom a reduction is sought further to the factors set out in section 10 of Reg. 552 under the Health Insurance Act.014-0280-82
Change of InformationForm used to change status of OHIP coverage - i.e., change of address, name, citizenship status, etc. or to cancel OHIP coverage or replacement of lost, stolen and damaged card014-4637-67
Application for Rehabilitation Assessor/Fitter/Dispenser StatusApplication for Rehabilitation Assessor/Fitter/Dispenser Status014-4744-84
IHP Application for Direct Bank PaymentForm used by IHPs to set up direct bank deposit014-2861-69
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.014-4777-87
Request for Zavesca® - Niemann Pick Type C (NPC)To facilitate prescribers making reimbursement claims for treatment of Niemann Pick Type C (NIPC).014-4717-87
Submission of Patient EvidenceTo provide patient advocacy groups with a template for written submissions to the ministry on a drug; the form is to make sure all the appropriate information is provided.on00488
Application for Registration of a Research Facility under s. 4 of the Animals for Research ActA registration is needed if you wish to operate a research, teaching, or testing facility in Ontario. This is required if your premises uses animals in research, teaching or testing and your premises are used for collecting, assembling, or maintaining of animals in connection with a research facility under R.S.O. 1990, c. A.22, s. 4. Please complete this application for registration of a research/teaching/testing facility in full, as per section 4 of the Animals for Research Act. The Director appointed under the Animals for Research Act will approve applications for registrations in accordance with the requirements of the Act. A registration expires on the 31st day of December of the year in which registration is made. Registration must be renewed annually. If an application includes more than one research, teaching or testing facility, details must be provided for each facility in the application, and payment of fees are required.
