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045-2308-69
Profile of Long-Term Care FacilityPart of Nursing Home Inspection Kit014-4818-69
Long-Term Care Home Support Document List - Resident Receiving ODSPTo 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.014-4817-69
Long-Term Care Home Support Document List - Submitting NOA that included benefit(s) that a resident is no longer receiving because they have transitioned to new benefit(s)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 have a Notice of Assessment from the year when they were 64 years of age.045-4806-69
Application for Reduction in Long-Term Care Home Basic Accommodation - Schedule B: Child DependantTo be used by residents of LTC homes who would like to apply for a reduction in the amount of their basic accommodation fees. This schedule should be used with one of the four main forms. An applicant should use this schedule if they would like to request a deduction to support an eligible child living in the community.045-4809-69
Application for Reduction in Long-Term Care Home Basic Accommodation - Resident Without Notice of Assessment (NOA)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 form is to be used by applicants who do not have a Notice of Assessment.045-4808-69
Application for Reduction in Long-Term Care Home Basic Accommodation - Resident With a Notice of Assessment (NOA)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 form is to be used by applicants who have a Notice of Assessment.014-4815-69
Rate Reduction Application in Long-Term Care - Document List Required for Assessment of Resident EligibilityTo 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 have a Notice of Assessment.014-4816-69
Rate Reduction Application in Long-Term Care - Document List Required for Assessment of Resident without NOATo 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 do not have a Notice of Assessment.014-4807-69
Application for Reduction in Long-Term Care Home Basic Accommodation - Schedule C: Continuation of Previous Dependant DeductionTo be used by residents of LTC homes who would like to apply for a reduction in the amount of their basic accommodation fees. This schedule should be used with one of the four main forms. An applicant should use this schedule if their LTC home has notified them that they are eligible for a “Continuation of Previous Dependant Deduction”.045-4805-69
Application for Reduction in Long-Term Care Home Basic Accommodation - Schedule A: Spouse DependantTo be used by residents of LTC homes who would like to apply for a reduction in the amount of their basic accommodation fees. This schedule should be used with one of the four main forms. An applicant should use this schedule if they would like to request a deduction to support an eligible spouse living in the community.045-4803-69
Application for Reduction in Long-Term Care Home Basic Accommodation - Resident with a Notice of Assessment and Transitioning to new Government Benefit(s)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 form is to be used by applicants who have a Notice of Assessment from the year when they were 64 years of age.045-4768-69e
Health Assessment - Ontario Health atHomePLEASE 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.5083-69
Withdrawal of Consent for Automated Income Verification with the Canada Revenue Agency –Long-Term Care Rate Reduction ProgramPlease complete this form if you wish to withdraw your consent to the Ministry of Long-Term Care (MLTC), Ministry of Finance and the Long-Term Care Home Licensee (LTCH Licensee) collecting your income information from the Canada Revenue Agency (CRA) using an Automated Income Verification (AIV) service for the purpose of MLTC assessing and administering your Application for Reduction in Long-Term Care Home Basic Accommodation (Application).5082-69
Application for Reduction in Long-Term Care Home Basic Accommodation – Consent to Collection, Use and Disclosure of Information for Automated Income Verification with the Canada Revenue AgencyPursuant to section 187 of the Fixing Long-Term Care Act, 2021, the Director may directly or indirectly collect the information provided in this application to determine the reduced amount payable by the resident for basic accommodation in accordance with section 303 of O. Reg. 246/22 made under the Fixing Long-Term Care Act, 2021. Pursuant to subsection 303(4) of O. Reg. 246/22, the licensee is required to submit this application and retain a copy.014-4652-87
Request for Myozyme®014-6430-41
Form 4 - Certificate of Renewal014-4323-04
Notice of Withdrawal014-3887-41
Home Staff Change Notification045-4767-69-lhin
Application for Determination of Eligibility for Long-Term Care Home Admission (Ontario Health atHome)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).
