This is the form that is prescribed as Form 5 under Ontario Regulation 181/03 made under the Municipal Act, 2001 (as that Regulation reads on or after January 1, 2018).
The Notice of Adverse Test Results and Issue Resolution form is to be used by licensed laboratories and owners/operators of small drinking water systems to support required written notifications pertaining to small drinking water system adverse water quality incidents (AWQI).
The Laboratory Services Notification (LSN) form is to be used by small drinking water system owners/operators to notify the local public health unit in writing as to which licensed laboratories will test drinking water samples for their small drinking water systems.
A parent must complete a Statement of Conscience or Religious Belief and have it witnessed by a commissioner for taking affidavits if they wish to obtain a non-medical exemption for their child from vaccine requirements under the Immunization of School Pupils Act.
A physician or nurse practitioner must complete a Statement of Medical Exemption for children who require a medical exemption from vaccine requirements under the Immunization of School Pupils Act.
Used by Toronto clients to return non-reusable vaccines (spoiled or expired) to the Ontario Government Pharmaceutical and Medical Supply Service
Healthy Smiles Ontario Change of Information form is a paper form submitted by mail as a result of a change during any benefit year. This form is used to add or change information about the applicant, marital status and/or spouse, and children/youth. This form is only required for those who have applied and been enrolled in the core services stream of the program.
Paper application required to register via mail. This form is submitted to authorize the MOHLTC (Oshawa) to deal with another person (such as your spouse or common-law partner, other family member, friend, or accountant) as your representative for HSO program matters.
Healthy Smiles Ontario General Application form for the core services stream of the program. This form applies to applicants that have a valid SIN and have filed a statement of income or a tax return with the CRA.
Prequalification form for health care agencies and workplaces that are required to prequalify in order to receive influenza vaccine.
User Agreement for Pharmacies Requesting Publicly Funded Influenza Vaccine in accordance with the UIIP Prequalification form for health care agencies and workplaces that are required to prequalify in order to receive influenza vaccine.
First Nations clients receiving Ontario Works will fill out this form and mail it to the HSO Program Administrator in order to enroll in the Healthy Smiles Ontario Program.
This form is to be used by fee-for-service dental providers to enroll clients into the Emergency and Essential Services Stream of Healthy Smiles Ontario.
