-
014-7026-65
Health Service Organization Information Sheet -
014-3143-04
New Accused Information Sheet -
014-3056-64
Daily Record of Spa Operation -
014-1667-88
Application for Physician Locum Programs -
014-4258-82
Health Card Renewal - ChildForm is generated by client communication system.006-fro-014
Third Party Authorization FormThe Third Party Authorization form authorizes a person other than the payor or recipient to act on the payor's or recipient's behalf. A Family Responsibility Office (FRO) support payor or support recipient may designate this person to request and receive information from the FRO regarding their case.014-2862-69
Medical Certificate Form 3Application used by First Nations and the North014-1057-82
(Change of Address form) What's Your Address?Form used to update/change address information of OHIP cardholders014-4420-84
Health Claim014-3975-87
Visudyne Therapy Registration/Funding EnrollmentApplication for reimbursement of cost due to use of Visudyne014-1948-95
Application for Direct Bank Payment - ADPUsed by clients/vendors to receive remuneration by direct deposit versus cheque.014-0280-82
Change of InformationForm used to change status of OHIP coverage - i.e., change of address, name, citizenship status, etc. or to cancel OHIP coverage or replacement of lost, stolen and damaged card014-4749-84
IHP Electronic Data Transfer (EDT) Undertaking and AcknowledgementForm related to EDT process for IHPs014-4742-84
Application for IHP Group RegistrationForm will be used by IHPs to form a registered group014-4367-84
Primary Health Care New Patient Declarationform used so that new patient to primary health group can join that group due to reasons on form014-4637-67
Application for Rehabilitation Assessor/Fitter/Dispenser StatusApplication for Rehabilitation Assessor/Fitter/Dispenser Status014-4744-84
IHP Application for Direct Bank PaymentForm used by IHPs to set up direct bank deposit014-3266-54
Application for Reduction of Assessed Co-payment FeesThis form is to be used for a patient who is seeking a reduction to the co-payment or for whom a reduction is sought further to the factors set out in section 10 of Reg. 552 under the Health Insurance Act.
