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on00521
Exceptional Access Program (EAP) – Biosimilar Exemption RequestThis form is only to be used by prescribers to request an exemption for Ontario’s Biosimilar Switch Policy for a patient who HAS BEEN USING AN ORIGINATOR BIOLOGIC REIMBURSED THROUGH THE ONTARIO DRUG BENEFIT (ODB) PROGRAM previously authorized through the Exceptional Access Program and is unable to switch from an originator biologic or who is requesting to switch back to the originator following biosimilar switch.014-4519-45
Do Not Resuscitate Confirmation FormUsed by Health Care Facility Staff and Regulated Health Care Providers. Submit completed order request form (available at https://forms.mgcs.gov.on.ca/en/dataset/014-0350-93) to OSSDistribution@ontario.ca.014-0350-93
Forms Order RequestUsed by Ministry clients to order forms from OSS Distribution.014-4846-87
Request for Aldurazyme®To facilitate prescribers making reimbursement claims for treatment of Hurler-Scheie and Hurler disease014-4816-69
Rate Reduction Application in Long-Term Care - Document List Required for Assessment of Resident without NOATo be used by residents of LTC homes who would like to apply for a reduction in the amount of their basic accommodation fees. This document guides applicants in determining which supporting documents will be required as part of their application. This document is to be used by applicants who do not have a Notice of Assessment.014-4792-67
Application for Funding Ventilator Equipment and SuppliesUsed to apply for Funding for Ventilator Equipment and Supplies014-4791-67
Application for Funding Enteral Feeding Pump and SuppliesUsed to apply for Funding for Enteral Feeding Pump and Supplies014-4392-67
Application for Funding Breast Prosthesis GrantUsed by clients to apply for funding for a silicone breast prosthesis(es)014-2196-67
Application for Funding Mobility DevicesApplication for Funding Mobility Devices014-1945-67
Application for Funding Ostomy GrantThe information on this form is used to determine eligibility for grant assistance under the Assistive Devices Program.014-4906-87
Fabry Disease Enzyme Replacement Therapy (Agalsidase) AssessmentApplication form for drug therapy for Fabry disease014-4421-84
Reciprocal ClaimClaim card used by physicians to receive reimbursement for reciprocal claims4976-47
Healthcare Provider Notification of MedsCheck ServicesUsing the standardized fax template, pharmacists must share the completed MedsCheck Personal Medication Record with the patient's primary prescriber. A record of the successfully transmitted fax must be kept on file at the pharmacy.014-4860-84
Vendor Application for Conformance Testing-Acceptable Use PolicyForm outlines the Conformance Testing-Acceptable Use Policy and is part of agreement between ministry and vendor who must successfully pass the conformance testing.014-3766-41
Form 50 - Confirmation of Rights Advice
