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Healthcare Provider Notification of MedsCheck Services
Using 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. -
Vendor Application for Conformance Testing-Acceptable Use Policy
Form outlines the Conformance Testing-Acceptable Use Policy and is part of agreement between ministry and vendor who must successfully pass the conformance testing. -
Pharmacy Requisition for Ontario Drug Benefit Approved Non-Prescription Drugs (ANPDs)
Use this form if you are an eligible pharmacy associated with LTCHs and need to order Ontario Drug Benefit Approved Non-Prescription Drugs (ANPDs) from OGPMSS. You are required to complete the form in its entirety for your orders to be processed. -
Consent Authorization Form: Disclosure of Personal Claims History (PCH) Information to Third Party
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. -
Clinician Aid C - (Secondary)"Medical Practitioner" or"Nurse Practitioner" Medical Assistance in Dying Aid
Complete this voluntary aid (Clinician Aid C) if you have been asked by a “Medical Practitioner” or “Nurse Practitioner” to provide a written opinion confirming that the Patient meets the eligibility criteria to receive medical assistance in dying. You should also include the completed aid in the patient's medical records. -
Clinician Aid B - (Primary) “Medical Practitioner” or “Nurse Practitioner” Medical Assistance in Dying Aid
The use of this aid is voluntary. It is being provided to assist you in maintaining records of requests for medical assistance in dying. Please use this aid if you are a “Medical Practitioner” or “Nurse Practitioner” and a patient is requesting medical assistance in dying and it is your intention to provide medical assistance in dying to the patient. You should also include the completed aid in the patient's medical records. -
Application for Trillium Drug Program (TDP)
For ODB recipients to apply Trillium Drug Program -
Request for Ilaris® (canakinumab)
Application for drug funding -
Request for Approval of Payment for Proposed Surgery
Form to request approval for patient to receive surgery out of Ontario -
IHP Application for Direct Bank Payment
Form used by IHPs to set up direct bank deposit -
Forms Order Request
Used by Ministry clients to order forms from OSS Distribution. -
AEMCA Examination Withdrawal and Refund Application
The withdrawal form is to be completed by individuals who have applied and paid to write the Ministry of Health (MOH) Advanced Emergency Medical Care Assistant (AEMCA) exam and now wish to withdraw from the exam. -
AEMCA Examination Application
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. -
Addendum for Ventilator Equipment and Supplies Application Form
Addendum for Ventilator Equipment and Supplies Application -
Application to Re-enter Postgraduate Medical Training
The Application Form collects information from applicants regarding their contact information, medical practice and education history. -
Application for Reduction in Long-Term Care Home Basic Accommodation - Schedule C: Continuation of Previous Dependant Deduction
To be used by residents of LTC homes who would like to apply for a reduction in the amount of their basic accommodation fees. This schedule should be used with one of the four main forms. An applicant should use this schedule if their LTC home has notified them that they are eligible for a “Continuation of Previous Dependant Deduction”.