Ministry of Health Forms
Forms used by Ministry of Health programs and services.
1. Drug Plan and Extended Benefits Branch Forms
Special Support - CRA Application/Consent Form ("Side A")
Completing Side A will authorize the Drug Plan and Extended Benefits Branch to obtain applicants' income tax information from the Canada Revenue Agency (CRA), so their coverage will be automatically renewed each year as long as they file income tax return with CRA.
Special Support - Annual Application ("Side B")
If applicants opt out of the automatic renewal process, they can manually complete this form each year and submit it with their annual income information.
Seniors' Drug Plan - CRA Application/Consent One-Time Application ("Form A")
Completing Side A will authorize the Drug Plan and Extended Benefits Branch to obtain applicants' income tax information from the Canada Revenue Agency (CRA), so their coverage will be automatically renewed each year as long as they file income tax return with CRA.
Seniors' Drug Plan - Annual Application ("Form B")
If applicants opt out of the automatic renewal process, they can manually complete this form each year and submit it with their annual income information.
Exception Drug Status Application - General Form
Exception Drug Status Application - Ankylosing Spondylitis Drugs
Exception Drug Status Application - Aricept/Exelon/Reminyl
Exception Drug Status Application – Hepatitis C Therapy
Tysabri Exception Drug Status Application
Gilenya Exception Drug Status Application
MS Drugs New Patient Application
Saskatchewan Insulin Pump Program Application
Prior Approval Medication Assessment and Compliance Packaging
Direct Deposit Payment Request Form
Certificate Authorization Form
Narcotics and Controlled Drugs
2. Medical Services Branch Forms
Direct Deposit Payment Request Form - Non-Professional Corporation
Direct Deposit Payment Request Form - Professional Corporation
Electronic Remittance Application - Multiple Physicians
Electronic Remittance Application - Single Physician
Medical Statement Request Application
New Clinic Request Application (for Health Providers use only)
Obstetric Ultrasounds - Billing Information Sheet
Physician Profile Request Form
Physician Request for Income Statement
Practitioner Change Request Form
3. Community Care Branch - Mental Health Forms
The Mental Health Services Act
Guide to The Mental Health Services Act
Consent for General Diagnostic and Treatment Services and Procedures on Voluntary Admission
Extracted from The Mental Health Services Regulations, pursuant to [Section 17 of The Mental Health Services Act]
Temporary Hold of Voluntary Patient by a Nurse in a Mental Health Centre
Extracted from The Mental Health Services Regulations, pursuant to [Section 30.1 of The Mental Health Services Act]
Form A - Certificate of Physician that Psychiatric Examination is Required
Extracted from The Mental Health Services Regulations, pursuant to [Section 18 of The Mental Health Services Act]
Form B - Information
Extracted from The Mental Health Services Regulations, pursuant to [Subsection 19(1) of The Mental Health Services Act]
Form C - Warrant to Apprehend
Extracted from The Mental Health Services Regulations, pursuant to [Subsection 19(2) of The Mental Health Services Act]
Form D - Order for Person from Outside Saskatchewan to be Taken Into Custody, Conveyed and Examined as an Out-patient
Extracted from The Mental Health Services Regulations, pursuant to [Section 21 of The Mental Health Services Act]
Form E - Order to Convey Person in Custody for Voluntary Examination
Extracted from The Mental Health Services Regulations, pursuant to [Subsection 22(2) of The Mental Health Services Act]
Form F - Order for Psychiatric Examination as an Out-patient
Extracted from The Mental Health Services Regulations, pursuant to [Subsection 22(3) of The Mental Health Services Act)
Order by the Director Requiring That a Person Submit to an Examination
Extracted from The Mental Health Services Regulations, pursuant to [Section 23.1 of The Mental Health Services Act] - Order by the Director Requiring That a Person Submit to an Examination
Form G - Certificate of medical practitioners for compulsory admission of a person to an in-patient facility
Extracted from The Mental Health Services Regulations, pursuant to [Section 24 of The Mental Health Services Act]
Form H - Revocation of certificate of committal
Extracted from The Mental Health Services Regulations, pursuant to [Subsection 24(9) and clause 31(1)(a) of The Mental Health Services Act]
Form H.1 - Order by a Judge for Detention of a Person
Extracted from The Mental Health Services Regulations, pursuant to [Subsection 24.1(3) of The Mental Health Services Act]
Form H.2 - Notification That a Detention Order has Expired or Been Rescinded
Extracted from The Mental Health Services Regulations, pursuant to [Subsection 24.1(8) of The Mental Health Services Act]
Form H.3 - Community Treatment Order
Extracted from The Mental Health Services Regulations, pursuant to [Section 24.3 of The Mental Health Services Act]
Form H.4 - Certificate in Support of a Community Treatment Order
Extracted from The Mental Health Services Regulations, pursuant to [Section 24.4 of The Mental Health Services Act]
Form H.5 - Notification by an Attending Physician Advising a Patient that a Community Treatment Order is No Longer in Effect
Extracted from The Mental Health Services Regulations, pursuant to [Subsection 24.5(2) of The Mental Health Services Act]
Form H.6 - Order to Revoke a Community Treatment Order
Extracted from The Mental Health Services Regulations, pursuant to [Subsection 24.5(3) of The Mental Health Services Act]
Form H.7 - Order for the Apprehension, Conveyance and Examination of a Person
Extracted from The Mental Health Services Regulations, pursuant to [Section 24.6 of The Mental Health Services Act]
Form I - Certificate for Electroconvulsive Therapy
Extracted from The Mental Health Services Regulations, pursuant to [Section 14]
Form J - Notification Regarding Appeal Procedures
Extracted from The Mental Health Services Regulations, pursuant to [Clause 14(4)(g)]
Form K - Order for Transfer
Extracted from The Mental Health Services Regulations, pursuant to [Section 28 of The Mental Health Services Act]
Form L.1 - Order of a Physician to Transfer a Patient from One Facility to Another Facility Within the Same Municipality
Extracted from The Mental Health Services Regulations, pursuant to [Subsection 28(6) of The Mental Health Services Act]
Form L.2 - Order by the Director to Return a Person to Another Jurisdiction
Extracted from The Mental Health Services Regulations, pursuant to [Subsection 28.2(3) of The Mental Health Services Act]
Form L.3 - Notice by an Attending Physician Advising a Patient that He or She is No Longer Subject to Detention Pursuant to Section 24
Extracted from The Mental Health Services Regulations, pursuant to [Section 31.1 of The Mental Health Services Act]
Form L.4 - Authorization for an Involuntary Patient to Receive Medical Services on a Hospital Unit other than a Designated Unit
Extracted from The Mental Health Services Regulations, pursuant to [Clause 29(a) of The Mental Health Services Regulations]
Form M - Notification Regarding Appeal Procedures
Extracted from The Mental Health Services Regulations, pursuant to [Section 33 of The Mental Health Services Act]
Form N - Appeal to Review Panel
Extracted from The Mental Health Services Regulations, pursuant to [Section 34 of The Mental Health Services Act; subsection 24(2) of The Mental Health Services Regulations]
Form N.1 - Appeal to Review Panel
Extracted from The Mental Health Services Regulations, pursuant to [Subsection 24.1 of The Mental Health Services Act]
Form O - Statement by Attending Physician to Review Panel
Extracted from The Mental Health Services Regulations, pursuant to [Section 22]
Form P - Authorization for money to be held in the patient's trust account
Extracted from The Mental Health Services Regulations, pursuant to [Clause 34(1)(b)]
Form - Decision of Review Panel
As a result of the investigation of the Review Panel appointed pursuant to Section 32 of The Mental Health Services Act
4. Community Care Branch - Long Term Care Forms
Long-Term Care forms are now available on the eHealth website under the Long-Term Care section.
5. Community Care Branch – Youth Drug Detoxification and Stabilization Act Forms
The Youth Drug and Detoxification and Stabilization Act
The Youth Drug and Detoxification and Stabilization Regulations
Form D - Notice to the Community Order is No Longer In Effect
Form F - Termination of Community Order or Detoxification Order
Form G - Notification that a Detoxification Order Has Expired
6. Other Ministry Forms
SECP Physician Application Form
Application must be submitted by physicians who want to be compensated for call rotations in which they treat new or unassigned patients.
SECP SHA Application Form
An application by a physician for the Specialist Emergency Coverage Program must be accompanied by an application from the Saskatchewan Health Authority.