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014-4372-64
Universal Influenza Immunization Program Reimbursement FormUniversal Influenza Immunization Program Reimbursement Form for influenza immunization clinics that are eligible for reimbursement through the Universal Influenza Immunization Program.014-4455-64
Universal Influenza Immunization Program Pharmacy FormUniversal Influenza Immunization Program Pharmacy Form for influenza immunization clinics that are eligible for reimbursement through the Universal Influenza Immunization Program.014-4580-64
Notice of Adverse Test Results and Issue ResolutionThe Notice of Adverse Test Results and Issue Resolution form is to be used by licensed laboratories and owners/operators of small drinking water systems to support required written notifications pertaining to small drinking water system adverse water quality incidents (AWQI).014-4907-87
Fabry Disease Enzyme Replacement Therapy (Agalsidase) RenewalRenewal form dor drug therapy for Fabry disease014-4817-69
Long-Term Care Home Support Document List - Submitting NOA that included benefit(s) that a resident is no longer receiving because they have transitioned to new benefit(s)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 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 have a Notice of Assessment from the year when they were 64 years of age.014-4347-84
Request for Major Eye Examinationform to be completed by those eligible for eye exams to be covered under OHIP014-4478-84
Adjustmentonline form to be available to providers and to Regional Operations staff on a permanent basis on the internet014-2859-69
Application for Services Form 1Application for services of a homemaker or a nurse014-3975-87
Visudyne Therapy Registration/Funding EnrollmentApplication for reimbursement of cost due to use of Visudyneon00325
Application for Emergency Admission to Secure Treatment ProgramEmergency admission of a child to a secure treatment program.014-2861-69
Consent to Inspect Assets Form 2Used to determine whether a person who is eligible for homemaking and nurses services is required to pay the fees prescribed for the services.014-4590-64
Response to Adverse Drinking Water Quality Incidents - ResolveThis form is completed by Public Health Boards when MOH site is down.014-0022-84
OHIP Group Registration for Health Care ProfessionalsForm used by physicians to register with group014-4594-84
Fact Sheet - Gift of Life Consent Form - Organ and Tissue Donor Registrationaccompanied with form completed by clients to record their wishes for organ/tissue donation014-5050-67
Vendor Registration Application - Home Oxygen TherapyThe Vendor Registration Application form is an interactive form that will be completed by an Ontario retailer or supplier of home oxygen therapy who is requesting registration with the Assistive Devices Program.014-4551-87
Application and Consent for the Inherited Metabolic Diseases (IMD) ProgramFor physicians and patients to apply for the Inherited Metabolic Disorders (IMD) Program.014-3266-54
Application for Reduction of Assessed Co-payment FeesThis form is to be used for a patient who is seeking a reduction to the co-payment or for whom a reduction is sought further to the factors set out in section 10 of Reg. 552 under the Health Insurance Act.
