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on00574
Provider Registration/Change Request FormThis application is to enable currently licensed health care professionals to be able to begin submitting or continue to submit claims to the Ministry of Health (the ministry) for insured services. Options include: • Register for an OHIP Billing Number • Register a Health Care Group • Authorize the ministry to make payments to a health care group on your behalf • Update address, banking, and/or group information • Register for Interactive Voice Response (IVR) • Register for the SAV Portal014-4897-64
Statement of Conscience or Religious Belief – Immunization of School Pupils ActA 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.014-4895-64
Statement of Medical Exemption – Immunization of School Pupils ActA 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.014-4347-84
Request for Major Eye Examinationform to be completed by those eligible for eye exams to be covered under OHIP4611-45
Paramedic Labour Mobility ApplicationApplication and Verification forms for the Ministry of Health (MOH) Paramedic Labour Mobility Equivalency for Paramedics who hold a valid license or certification in good standing from other Canadian provinces or territories and wish to obtain equivalency in Ontario for their paramedic qualification.014-4823-67
Application for Funding Pressure Modification DevicesUsed to apply for Funding for Pressure Modification Devices014-4819-67
Application for Funding Orthotic DevicesUsed by Canadian board -certified orthotists registered with ADP to request funding for custom -made orthoses014-4658-67
Application for Funding Ocular ProsthesesUsed to apply for Funding for Ocular Prostheses014-2451-67
Application for Funding Home Oxygen TherapyTo be used for all applications for Home Oxygen Therapy funding.014-2196-67
Application for Funding Mobility DevicesApplication for Funding Mobility Deviceson00323
Application for Funding Real-Time Continuous Glucose Monitoring System (rtCGM)Used to apply for Funding Continuous Glucose Monitors (CGM) Supplies014-4825-67
Application for Funding Communication AidsUsed to apply for Funding for Communication Aids014-4824-67
Application for Funding Visual AidsUsed to apply for Funding for Visual Aids014-4821-67
Application for Funding Maxillofacial Extraoral ProsthesesFor Specialist physician & ADP registered authorizers to request funding for extraoral (facial) prostheses.014-4820-67
Application for Funding Maxillofacial Intraoral ProsthesesFor Specialist physician & ADP registered authorizer to request funding for intraoral (mouth) prostheses.014-4793-67
Application for Funding - Respiratory Equipment & SuppliesUsed to apply for Funding for Respiratory Equipment & Supplies014-4791-67
Application for Funding Enteral Feeding Pump and SuppliesUsed to apply for Funding for Enteral Feeding Pump and Supplies014-4537-67
Application for Funding Insulin Pumps and Supplies for AdultsApplication used to determine elegibility for funding by ADP for insulin pumps and supplies
