 | All Forms |
| Legislation |
| Orders In Council |
| Associations |
| Ministry / Agency List |
| Municipalities |
| View Shopping Cart |
| Advanced Search |
| Customer Service |
| Links |
|
Health Categories
|
Health |
Product List for Forms
| A | B | C | D | E | H | I | M | N | O | P | R | S | W | | ||
| A | ||
 |
Application for Pharmacy Payment Vendor Code - (for Pharmacy Use Only) Form filled by pharmacists to arrange payment for pharmacy claims through Saskatchewan Finanace. |
|
|
Aricept/Exelon/Reminyl Exception Drug Status Application - (for Physician Use Only) Application form used by physicians to request drug coverage for Aricept or Exelon on behalf of their patients. |
|
 |
Back To Top | |
| B | ||
|
Birth Certificate Application This forms allows you to order a copy of your birth certificate. |
|
|
Birth Certificate Application (French) This form allows you to order a birth certificate (French). |
|
|
Back To Top | |
| C | ||
|
Chiropractor Questionnaire To obtain pertinent information about the Chiropractor who is registering with the Chiropractors' Association of Saskatchewan. |
|
|
Back To Top | |
| D | ||
|
Death Certificate Application This form allows you to order a death certificate. |
|
|
Death Certificate Application (French) This form allows you to apply for a death certificate (French). |
|
|
Declaration of Hospital Insurance Coverage To ensure that a non-resident receiving services has health coverage in another province. |
|
|
Dental Questionnaire To obtain pertinent information about a Dentist who is registering with the College of Dental Surgeons of Saskatchewan. |
|
|
Direct Deposit Payment Request Form - (for Pharmacy Use Only) Form used by pharmacists to arrange direct payment for pharmacy claims. |
|
|
Drug Plan - Cancelled Claims Advisory - (for Pharmacy Use Only) Allows pharmacies to cancel claims already adjudicated electronically but cannot be reversed electronically. |
|
|
Drug Plan - Certificate Authorization Form Pharmacists must complete form to receive certificates for security purposes. The certificates ensure that only pharmacies access the drug plan data base. |
|
|
Back To Top | |
| E | ||
|
Exception Drug Status Application for Ankylosing Spondylitis Drugs - (for Rheumatologist Use Only) Application form used by Rheumatologists to request Exception drug status coverge for drugs used to treat Ankylosing Spondylitis on behalf of their patients/ clients. |
|
|
Exception Drug Status Request Fax Form - (for Pharmacy or Physician Use Only) Application form used by physicians and pharmacists to request Exception drug status coverage on behalf of their patients/ clients. |
|
|
Back To Top | |
| H | ||
|
Health Services Card Application Used by new and returning residents to apply for provincial health coverage. Form is to be completed immediately following the establishing of Saskatchewan residency. |
|
|
Home Care Admission To admit home care clients to the home care program. |
|
|
Home Care Discharge To discharge home care clients to the home care program. |
|
|
Back To Top | |
| I | ||
|
Institutional Supportive Care Admission/ Discharge Form Used to collect admissions and discharges information in long term care facilities. |
|
|
Institutional Supportive Care Income-Tested Resident Charge -Side A- CRA Consent Form This consent form authorizes Canada Revenue Agency (CRA) to supply total income each year to Drug Plan & Extended Benefits in order to calculate the income-tested resident charge. |
|
|
Institutional Supportive Care Income-Tested Resident Charge -Side B- Annual Consent Form This consent form is used to request income information each year in order to calculate the income-tested resident charge. |
|
|
Institutional Supportive Care Long Term Care Optional Designation for Determining Resident Charge Married residents may choose to complete this form to calculate the long-term care resident charge using the resident's income only. |
|
|
Institutional Supportive Care Long Term Care Resident Nomination and Consent Form To provide information for the designated representative of a resident in long term care. |
|
|
Institutional Supportive Care Order Form For use by long-term care staff to request copies of forms from SPM. |
|
|
Institutional Supportive Care Special Care Home Level of Care Change Used by long term care staff when level of care changes. |
|
|
Internet Claims Submission Service Subscriber Application Application to set up practitioners to submit claims via the Internet to the Medical Services Branch |
|
|
Back To Top | |
| M | ||
|
Marriage Certificate Application This form allows you to order a marriage certificate. |
|
|
Marriage Certificate Application (French) This form allows you to apply for a marriage certificate (French). |
|
|
MS Drugs Exception Status Application - (for Physician Use Only) Application form used by physicians to request coverage (on behalf of their patients) for drugs used in treatment of multiple sclerosis, specifically Betaseron/Copaxone/Rebif/Avonex-form is submitted to the MS Drug Advisory Panel for review. |
|
|
Back To Top | |
| N | ||
|
Narcotics and Controlled Drugs For use by staff in long term care facilities to track drug usage. |
|
|
Back To Top | |
| O | ||
|
Optometrist Questionnaire To obtain pertinent information about the Optometrist who is registering with the Saskatchewan Association of Optometrists. |
|
|
Out of Province Beneficiary Hospital Admission - AS1 To collect hospital in-patient claims information for out of province beneficiaries receiving services in Saskatchewan Hospitals. |
|
|
Out of Province Beneficiary Hospital Admission - AS2 To collect hospital in-patient claims information for out of province beneficiaries receiving services in Saskatchewan hospitals. |
|
|
Out of Province Out-Patient Services To collect out-patient billing information for out of province beneficiaries, receiving services in Saskatchewan Hospitals. |
|
|
Back To Top | |
| P | ||
|
Personal Care Homes Admission Form To be completed for every resident admitted to a personal care home. |
|
|
Personal Care Homes Authorization to Receive Confidential Information To obtain informaton regarding applicant's history and/or ability as a care provider. |
|
|
Personal Care Homes Criminal Record Check Used to gather necessary information to assess if a personal care home license can be issued. |
|
|
Personal Care Homes Discharge Form To be completed for every resident discharged from a personal care home. |
|
|
Pharmacy Claim - In Province - (for Pharmacy Use Only) Manual billing of prescription claims from community pharmacies located in Saskatchewan. These pharmacies submit the claim for payment if the claim is not electronically adjudicated on the Drug Plan network. Some reasons may be because of quantity restrictions or a change in coverage. |
|
|
Pharmacy Claim - Out of Province - (for Pharmacy Use Only) Manual billing of prescription claims from out patient hospital pharmacies located outside of Saskatchewan. These pharmacies submit the claim so patients receiving treatment outside of the province don't pay costs or pay as they would if in Saskatchewan |
|
|
Physician Profile Request Form The Medical Services Branch prepares practitioner profiles on a fiscal year basis. The fiscal year begins April 1 and ends March 31 of the following year. |
|
|
Physician Questionnaire To obtain pertinent information about a Physician who is registering with the College of Physicians and Surgeons of Saskatchewan. |
|
|
Professional Corporation For use by physician to provide pertinent information about his/her Professional Corporation |
|
|
Back To Top | |
| R | ||
|
Request for Palliative Care Coverage - (for Physician Use Only) Application form completed by physicians on behalf of their patients to request Palliative Care drug coverage under the Drug Plan. |
|
|
Request for Review of Claim Assessment Allows the doctor to request a review of a paid claim which he believes should be paid at a higher or lower rate of payment. |
|
|
Review of Level of Care For use by the long term care staff in health region facilities. |
|
|
Back To Top | |
| S | ||
|
Saskatchewan Student Certification Used to verify enrollment for a new student who is temporarily absent from Saskatchewan OR who is temporarily resident in Saskatchewan to further their education. |
|
|
Seniors' Drug Plan - Form A - CRA Application/Consent One-Time Application To apply for the Seniors' Drug Plan program, each eligible senior must complete and sign an application and consent form. By using Form A, you are giving the Drug Plan and Extended Benefits Branch permission to update your coverage annually. |
|
|
Seniors' Drug Plan - Form B - Annual Application To apply for the Seniors' Drug Plan, use Form A for a one-time application or this form which is to be completed and submitted with your income information each year. |
|
|
Special Support Program - Drug Plan - Side A - CRA Application/Consent Form This form is used to request income information for assessment of eligibility for those with high drug costs in relation to income. This one-time form authorizes the Drug Plan to obtain your income tax information from Canada Revenue Agency (CRA), so you do not need to apply every year. If you decide you do not want the automatic renewal process, the Annual Application Form (SIDE B) allows you to complete a renewal form and submit it with your income information each year. |
|
|
Special Support Program - Drug Plan - Side B - Annual Application This form is used to request income information for assessment of eligibility for those with high drug costs in relation to income. You must complete this form and submit it with your income information each year. If you prefer to submit a one-time form that authorizes the Drug Plan to obtain your income tax information from Canada Revenue Agency (CRA), please use the CRA Application/Consent Form SIDE A). |
|
|
Back To Top | |
| W | ||
|
Water Analysis Requisition - Provincial Laboratory (for Municipal-Saskatchewan Environment only) Used to submit water samples from Saskatchewan Environment regulated sites. |
|
|
Water Analysis Requisition - Provincial Laboratory (for Private Users Only) Used by private individuals to submit drinking water samples for analysis at the Provincial Laboratory. |
|
|
Water Analysis Requisition - Provincial Laboratory (for Public Health only) Used to submit water samples from Public Health regulated sites for analysis at the Provincial Laboratory. |
|
|
Back To Top | |