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Forms and Applications : Ontario Drug Benefit Program (ODB)

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.

4423-87 Notification for Change of Information for Trillium Drug Program VIEW & PRINT
4406-87 Request for an Unlisted Drug Product - ICR  FILL & PRINT
4253-87 Request for Plavix (clopidogrel) Individual Clinical Review  FILL & PRINT
4252-87 Request for an Unlisted Oral Antidiabetic Drug for Type 2 Diabetes  FILL & PRINT
3693-87 Application for Ontario Drug Benefits (4 pages)
Trillium Drug Program Guide (25 pages)
PAPER COPY ONLY
VIEW & PRINT
3233-87 Co-payment Application for Seniors  VIEW & PRINT
4247-87 ”Guide” for the Co-payment Application for Seniors

Mail completed Co-payment Applications to the following address for processing :

Drug Benefit Programs - MOHLTC
P.O. Box 384
Etobicoke ON M9A 4X3

Questions regarding the Co-payment Application form/guide should be directed as follows :

In Toronto, call 416-503-4586
Toll-free: 1-888-405-0405 or
E-mail : seniorscopayment@resolve.ca

VIEW & PRINT
2784-87 Drug Benefit Claim/Reversal  FILL & PRINT
3057-87 Nutrition Products  PAPER COPY ONLY
VIEW & 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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