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014-4406-87
Request for an Unlisted Drug Product - Exceptional Access Program (EAP)For faster decisions, prescribers can use the SADIE online portal to submit requests to the Exceptional Access Program (EAP). Sign in through GO Secure (https://www.ebse.health.gov.on.ca) and select SADIE from the services drop-down menu. Visit the SADIE website for more information: http://www.ontario.ca/sadie. Alternatively, this form can be used for submitting requests to the EAP by fax.004-0319
Vulnerable Victims and Family Fund RequestFor eligible victims of crime and their families who wish to apply for financial assistance and other supports available under the Vulnerable Victims and Family Fund.014-4442-97
Return Authorization for Resalable Drugs and Medical SuppliesUse this form if you ordered drugs and/or medical supplies from OGPMSS and wish to return resalable drugs and/or medical supplies to OGPMSS. OGPMSS will only accept returns and provide credit for resalable drugs or supplies that meet the criteria listed on the form. OGPMSS will provide you with a Return Authorization Number within 2 business days upon receipt of a completed form.014-2861-69
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.014-4500-69
Determination of Available Monthly Income Form 4Used for the determination of applicant's available monthly income.021-0471
Community Standard Questionnaire019-0253
Application for Determination of Surface Rights CompensationIf the owner of surface rights considers that a mining claim holder, of the same land, damaged the owners surface rights and is refusing to compensate the surface rights owner, then that owner can send this form to the Mining and Lands Commissioner.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).004-0318
Prescribed Form of Summons Under Subsection 33(4) of the ActThe purpose of this form is for a Summons under s. 33(4) of the Public Inquiries Act, 2009.012-2031
Summary of Planned and Completed Pesticide Aerial Applications in Ontario Crown ForestsA person who operates an airborne machine in performing a land extermination on Crown Land is required to make a record of each extermination. This is the form to maintain this summary.021-0459
One Week Survey of Public Library Use (Typical Week Survey)Typical Week Survey helps Ontario public libraries and First Nations public libraries to record, and then report on, their public library usage. Typical Week Survey is annually done in November and data from it is used in the Annual Survey of Public Libraries.008-0133
Affidavit of Service of Summons014-4717-87
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.012-2029
Record of Land and Water Exterminations by an Airborne MachineA person who operates an airborne machine in performing a land or water extermination is required under regulation to make a record of each extermination. This is the form to maintain this record.014-4723-87
Submission of Patient Evidence Patient Advocacy Groups - Registration FormTo allow patient advocacy groups to register into the database so that they provide written submissions to the ministry on a drug; the form is to make sure all the appropriate information is provided.
