PLEASE NOTE: The Health Assessment Form has been updated as of July 7th, 2025. Practitioners are asked to begin using the new form immediately. However, assessments completed using the old form will be accepted by Ontario Health atHome until December 31st, 2025.
This form is to be used for completion of the assessment required under the Fixing Long-Term Care Act, 2021 when a person applies for a determination of eligibility for long-term care home admission. The required assessment is of the applicant’s physical and mental health, and the applicant’s requirements for medical treatment and health care. This assessment must be made by a physician or registered nurse.
Used to determine whether a person who is eligible for homemaking and nurses services is required to pay the fees prescribed for the services.
Used for the determination of applicant's available monthly income.
Application used by Homemaker and Nurses to request reimbursement from the Province for services provided.
Application for a Licence to Establish or Maintain and Operate a Nursing Home
