Used by clients to request funding assistance for Insulin Pumps and Supplies for Children

Transfer of ownership of Integrated Community Health Services Centre (ICHSC) licence.

Licensees of Integrated Community Health Services Centres (ICHSCs) must submit an application and obtain written approval from the Director of Integrated Community Health Services Centres prior to a centre’s relocation. For the purposes of this application, a “Fixed Site” centre is a licensed ICHSC where the Limitations and Conditions of the licence specify a single geographic location or address where specified services may be provided.

The form is used to confirm a physician's qualifications to provide the requested services prior to processing a request to affiliate to a particular ICHSC. The licensee must ensure that the physician has been affiliated to the centre before they begin to provide licensed services.

The ICHSC Program must be notified of a change in quality assurance advisor through the submission of the Quality Assurance Advisor form which must be signed by both the centre’s quality assurance advisor and the licensee.

This form is to be used by Public Health Units after dental screening to notify parents/guardians that their child would benefit from preventive dental services. If the parent/guardian can complete the form and return it to the Public Health Unit if they wish to enroll their child into the Preventive Services Only Stream of Healthy Smiles Ontario.

Form authorizes the ministry to disclose an individual's personal claims history information directly to a third party.

Used to renew funding for home oxygen therapy.

The Ministry of Health and Long-Term Care's Assistive Devices Program provides customer centered support and funding to Ontario residents who have long-term physical disabilities to provide access to personalized assistive devices appropriate for the individual's basic needs. To accomplish this goal the ADP must establish relationships with health professionals in order to ensure that ADP clients are assessed for cost-effective devices that best suit their needs.

Used by public health units when conducting cold chain maintenance inspections in premises that store publicly funded vaccines.

Form is generated by client communication system to have people come in to renew photo health card

Receive information required to process Personal Claims History information requests from individuals or individual's substitute decision makers.

Physicians complete form to indicate their preference on how malpractice reimbursement will be sent to them.

Form used so patient can submit out of country medical receipts

Used by Mental Health Professional to request Rights Advice for both patient and SDM (if indicated). Form completed when Community Treatment Plan (CTP) and Form 49 are issued by physician. Form, CTP and Form 49 faxed to PPAO.

Used by Mental Health Inpatient Unit staff to request Rights Advice. Form is completed when a physician issues a Mental Health Act form that requires the provision of Rights Advice. Fax form to the PPAO and Rights Adviser will be assigned

Form used by physicians to make inquiries regarding payment details on Remittance Advice

Receive information required to prove consent provided by individuals or individual's decision makers in order to process Personal Claims History information requests from Third Parties.

Used by Toronto clients to return non-reusable vaccines (spoiled or expired) to the Ontario Government Pharmaceutical and Medical Supply Service

“The Digital Health Drug Repository (DHDR) Reference Guide may be used by health care providers to understand the inclusions and limitations of the information available through the DHDR.”