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045-4767-69-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).014-1057-82
(Change of Address form) What's Your Address?Form used to update/change address information of OHIP cardholders014-4658-67
Application for Funding Ocular ProsthesesUsed to apply for Funding for Ocular Prostheses014-3324e-53
Appointment of Radiation Protection Officer014-5069-87
Drug Benefit Claim Reversal FormUsed by pharmacies for submitting claims or reversals014-4508-67
Insulin Pump Product EvaluationUsed to evaluate Insulin pumps014-5055-67
Authorizer Registration Change RequestTo maintain registration of health care professionals, termed authorizers, by the Assistive Devices Program014-4509-67
Application for Equipment Listing Insulin PumpsUse by vendor/manufacturer to apply for equipment listing insulin pumps.014-3975-87
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.014-3523-87
Ontario Drug Programs Enrollment Form014-4446-67
Application for Funding Insulin Pumps and Supplies for ChildrenUsed by clients to request funding assistance for Insulin Pumps and Supplies for Children
