Forms

Homes for Special Care Program

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.

4482-41 Application for Reduction in Home for Special Care Rent and Care Fees Fill & Print
3886-41 Financial Responsibility Acknowledgement for Tenants of Homes for Special Care Fill & Print
3657-41 Funding Request - Accompanying a Home for Special Care (HSC) Tenant to a Medical or Legal (Court Ordered) Appointment Fill & Print
3854-41 Application for Home for Special Care Licence and Agreement Fill & Print
5486-92 Invoice Summary - Homes for Special Care Fill, Print &.
Save
2002-41 Approval to Purchase Clothing Paper copy.
Available.
Fill & Print
3653-41 Dental Claim Fill & Print
3651-41 Funding Request - Prescribed Drugs not covered by ODB Plan Fill & Print
3887-41 Home Staff Change Notification Fill & Print
3332-41 Operator's Incident Report - Homes for Special Care Fill & Print
3883-41 Program Funding Request Fill & Print
3592-41 Residential Home Amendment Form Fill & Print
4865-41 Home for Special Care Licence Recommendation Fill & Print
3829-41 Home for Special Care Licence Inspection Report Fill & Print
3884-41 Review Findings Fill & Print

For More Information

Call ServiceOntario, Infoline at:
1-866-532-3161 (Toll-free in Ontario only)
TTY 1-800-387-5559.
In Toronto, TTY 416-327-4282
Hours of operation : 8:30am - 5:00pm