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Forms and Applications : Primary Health Care

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.

Professional Forms

4431-84 Unattached Patient Declaration FILL & PRINT
3624-84 Request to Remove Patient FILL & PRINT
4316-84 Patient Enrolment Batch Header FILL & PRINT
4324-84 Request for an Interim Assigned Roster Report FILL & PRINT
4327-84 Invoice for Reimbursement of Continuing Medical Education (CME) FILL & PRINT
4340-84 Time and Location of After Hours Services FILL & PRINT
4342-84 List of Locations Where Group Services are Regularly Provided FILL & PRINT
4367-84 Primary Health Care New Patient Declaration FILL & PRINT

For more information
Call the ministry INFOline at 1-866-532-3161
(Toll-free in Ontario only)
TTY 1-800-387-5559
Hours of operation : 8:30am - 5:00pm
  
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