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.
Application used by Homemaker and Nurses to request reimbursement from the Province for services provided.
Part of Nursing Home Inspection Kit
Application used by First Nations and the North
To 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 are receiving benefits from the Ontario Disability Support Program.
To be filled out by long-term care (LTC) home applicants as part of the process for determination of eligibility for admission to a LTC home. This completed form is for use by Ontario Health atHome, as the designated placement co-ordinators for long-term care homes, as per the Fixing Long-Term Care Act, 2021, s 47(1).
Used for the determination of applicant's available monthly income.
