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Résultats 1 à 10 sur un total d 71 .

Résultats

Family Health Benefit Application Form

https://www.princeedwardisland.ca/sites/default/files/forms/family_health_benefit_application_form.pdf
2023-05-09
Complete this form to apply for the Family Health Benefit Drug Program.
Family Health Benefit Personal Information (please print) Applicant Spouse (if applicable) Surname Surname First Name Initial First Name Initial PEI Health Care Card number PEI Health Care Card number (PHN) Date of...

High Cost Drug Program Application Form

https://www.princeedwardisland.ca/sites/default/files/forms/high_cost_drug_program_application.pdf
2023-05-09
Complete this form if you need assistance paying for expensive medications. You may be eligible for coverage of approved medication costs through the High Cost Drug Program.  
High Cost Drug Program Personal Information (please print) Applicant Spouse (if applicable) Surname Surname First Name Initial First Name Initial PEI Health Care Card number PEI Health Care Card...

Catastrophic Drug Program Application Form

https://www.princeedwardisland.ca/sites/default/files/forms/catastrophic_drug_program_application_form.pdf
2023-05-09
Complete this form to apply for coverage of medication through the Catastrophic Drug Program.
Catastrophic Drug Program Personal Information (please print) Applicant Spouse (if applicable) Surname Surname First Name Initial First Name Initial PEI Health Care Card number PEI Health Care Card number Date of...

Ostomy Supplies Program - Patient Application

https://www.princeedwardisland.ca/sites/default/files/forms/ostomy_supplies_program_patient_application.pdf
2023-05-09
To apply for the Ostomy Supplies Program , you must complete this form as part of the application process.  
One Island Health System OSTOMY SUPPLIES PROGRAM PATIENT APPLICATION Personal Information (please print) Applicant Spouse (if applicable) Surname Surname First Name Initial First Name Initial PEI Health Card number (PHN...

Formulaire de demande Programme provincial de soins dentaires

https://www.princeedwardisland.ca/sites/default/files/forms/formulaire_de_demande_programme_provincial_de_soins_dentaires.pdf
2023-05-05
Un système de santé unique Services de santé dentaire 152, chemin St. Peter’s C.P. 2000 Charlottetown (Î.-P.-É.) C1A 7N8 Téléphone 902-368-5460 Sans frais 1-866-368-5460 Programme provincial de soins dentaires Formulaire de demande...

Ambulance Services Fee Review Form

https://www.princeedwardisland.ca/sites/default/files/forms/ambulanceservicesfeereviewform_october2022.pdf
2022-10-11
EHS- AMBULANCE SERVICES FEE REVIEW FORM PAGE 1 EMERGENCY HEALTH SERVICES Ambulance Services Fee Review Form Please review and complete the below form to request a review of an ambulance service fee levied on the care received from...

DASH Referral Form

https://www.princeedwardisland.ca/sites/default/files/forms/dash_referral_form.pdf
2022-08-02
Dash Program Referral Form
Microsoft Word - DASH Referral Form Client Last Name:  Client First Name:  PHN/MRN:  Date of Birth:  Phone Number:  Client aware of referral?   Yes       No    Contact Person (if  different from client):  Contact Person’s  relationship to client...

Substance Use Harm Reduction Client Registration Form

https://www.princeedwardisland.ca/sites/default/files/forms/substance_use_harm_reduction_client_registration_form.pdf
2022-05-18
PATIENT REGISTRATION FORM SUBSTANCE USE HARM REDUCTION DRUG PROGRAM Fax requests to (902) 368-4905 OR mail requests to PEI Pharmacare, P....

Council of the Federation Award for Innovation in Mental Health and Addictions Care Nomination Form

https://www.princeedwardisland.ca/sites/default/files/forms/cofmhaawardnominationform.pdf
2022-04-04
Complete this form to nominate an initiative, project, study or program and associated team for the Council of Federation Award for Innovation in Mental Health and Addictions Care.
Nomination Template: COF MH&A Award Page 1 of 7 Council of the Federation Award for Innovation in Mental Health and Addictions Care Nomination Template Purpose of the Award Mental health and addictions are complex issues that impact many...

Out-of-Province Travel Support Application

https://www.princeedwardisland.ca/fr/formulaire/out-of-province-travel-support-application
2022-03-30
Complete this form to apply for out-of-province travel support for medical services with the Maritime Bus Program. Apply online at least 10 days prior to out-of-province travel.

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