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014-3266-54
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.003-nm-005
Nutrient Management Farm Registration FormTo register your Farm Unit under the Nutrient Management Program.003-nm-001
Farm Unit DeclarationTo identify properties included as part of the farm unit for the purposes of the Nutrient Management Act.014-4573-84
Primary Health Care Request to Change Designated Physician - Group EnrolmentUsed by primary care groups who have opted for group enrolment and consent and is only for changing the designated physician of individual patients.014-7158-84
In-Patient Standard Ward Costsform used for inpatients to Ontario hospitals who are here visiting from other provinces014-2404-84
Claims Flagged for Manual Reviewform submitted with claims to provide additional information regarding particular claim014-4316-84
Patient Enrolment Batch Headerform placed on top of bundles of primary care forms, to submit to ministry for processing.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.006-3216
Direct Bank Deposit (Electronic Funds Transfer) Enrolment / Change of Information Third Party PayeesTo support direct bank deposit enrolment and information management for third party vendor records in Social Assistance Programs04-0201
Non-Agricultural Source Materials (NASM) Plan Registration FormTo register agricultural operations that intend to land apply Catergory 2 non-agricultural source materials (NASM) with a low metals content.006-fro-003
Request for Director's Statement of Arrears (Statement of Account)The Request for Director's Statement of Arrears is another term for statement of account. If a client wants to obtain a statement of their account, they must contact the Family Responsibility Office.The first statement of account will be free while any subsequent requests will be subject to a $25 fee.014-3134-84
Application For IVR ParticipationProvider/hospital applies for Interactive Voice Response to verify Health Card numbers via telephone003-atdia-005
Application To Upgrade a Machine Operator's LicenceAn application is required in order upgrade a machine operator's licence used to operate a tile drainage machine.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.014-3975-87
Visudyne Therapy Registration/Funding EnrollmentApplication for reimbursement of cost due to use of Visudyne
