Health Care Provider Access to Prescription Drug History
Consent Withdrawal / Reinstatement Forms for Ontario Drug Benefit program Recipients
Forms are listed alphabetically in Portable Document Format (PDF). To view and print the forms, you need to have Adobe Acrobat® Reader installed on your computer. You can download this free software from the Adobe Web site.
Click on the form title to open the form. You can fill-in the form on your screen and print it, or use the disk icon on the Reader toolbar to save a blank copy of the form to your computer. Filled-in forms cannot be saved.
To print, use the printer icon on the Reader toolbar. For form sizes larger than 8.5 x 11 inches, check the Fit to Page box in the print menu window. See the Forms and Applications main menu page for detailed instructions.
|4385-87||Full Withdrawal of Consent||Fill & Print|
|4386-87||Partial Withdrawal of Consent||Fill & Print|
|4387-87||Consent Reinstatement||Fill & Print|