For Specialist physician & ADP registered authorizers to request funding for extraoral (facial) prostheses.

For Specialist physician & ADP registered authorizer to request funding for intraoral (mouth) prostheses.

Used to apply for Funding for Respiratory Equipment & Supplies

Used to apply for Funding for Enteral Feeding Pump and Supplies

Application used to determine elegibility for funding by ADP for insulin pumps and supplies

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

Used by clients to apply for funding for a silicone breast prosthesis(es)

Application used to determine eligibility for funding by ADP for Hearing Devices.

Used by Amputee Team, registered with ADP to request funding for conventional upper/lower limb prosthees.

The information on this form is used to determine eligibility for grant assistance under the Assistive Devices Program.

Used by senior clients, 65 years and older, who are on daily insulin injections to apply for funding for syringes.

You may use this application form to apply for the Ontario Seniors Dental Care Program if you and your spouse (if applicable) have filed your Personal Tax Return(s) with Canada Revenue Agency (CRA) for the most recent tax year and have a valid Social Insurance Number (SIN). If you have a spouse (married or common law partner) who would also like to apply for the Program, they must complete their own application form.

Used to apply for financial travel assistance by Northern Ontario residents who must travel long distances to access medical specialist services.

The application form is for candidates who have either successfully completed the Paramedic training program provided by an approved College or Training Institution or have been considered equivalent through the MOH Standard Paramedic Equivalency Process and wish to write to write the Ministry of Health (MOH) Advanced Emergency Medical Care Assistant (AEMCA) examination.

Application used by Homemaker and Nurses to request reimbursement from the Province for services provided.

Form created with public health. Eligible uninsured patients diagnosed/treated for TB, physicians submit form to get paid

he purpose of this form is to collect necessary information to obtain authorized consent and assure identity, under the Freedom of Information and Protection of Privacy Act (FIPPA), for application of services delivered by the Ministry of Health on your behalf (or for a “Health Care Group” in which you are a registered member), including: • Application for an OHIP Billing Number • Changes to Health Care Group Registration Information

This form is to be used by Public Health Units after dental screening to notify parents/guardians that their child has an emergency and/or essential dental condition(s). Parents/Guardian will complete the form and return it to the Public Health Unit to let them know that the child has initiated treatment or to attest to financial hardship and enroll into the Emergency and Essential Services Stream of Healthy Smiles Ontario.

The Application Form collects information from applicants regarding their contact information, medical practice and education history.

The OOC/OOP PA Program eForm is designed to be completed and submitted electronically for application for prior approval for full payment of insured Out-of-Country (OOC) & Out-of-Province (OOP) laboratory and genetics testing services. English and French versions can be completed online or downloaded and saved for future use.