Online Services & Data Request Forms

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PharmaNet Forms, health data requests, requests to contact, checklists for submitting data requests.

Medical Practice Access to PharmaNet Forms

Form #	Form Name and Information
7092	Request to Update Physician and Medical Practice Information (online submission)
7094	Request to Update Supervised Persons Information (online submission)

Health Data Request Forms

Form 5424 and 5427 are intended for academic researchers who are interested in initiating a Request to Contact application or need a cost estimate for a PharmaNet data extract. Form 5426 and corresponding checklists are intended for Health Authorities or other organizations who are interested in applying for record level Ministry of Health data. For more information please visit Web Service Applications.

Form #	Form Name and Information
5422	Request for Information Release by the Minister of Health or Person Designated by the Minister, or by a College or a Regulatory Body for a Practitioner (PDF, 532KB)
5424	Request to Contact (PDF, 542KB)
5426	Health Data Request (PDF, 613KB)
5427	Request for Estimate (PDF, 536KB)
5429	Checklist: Discharge Abstract Database (Hospital Separations) Data File (PDF, 651KB) Data Dictionary for HLTH 5429 (PDF, 94KB)
5430	Checklist: Medical Services Plan (MSP) Payment Information (PDF, 610KB) Data Dictionary for HLTH 5430 (PDF, 61KB)
5431	Checklist: PharmaNet Data (PDF, 602KB) Data Dictionary for HLTH 5431 (PDF, 66KB)
5451	Application for Data from the Ministry of Health for Evaluation and Planning Purposes (PDF, 528KB)
5452	Application for Data for Evaluation and Planning Purposes from the Ministry of Health: Chronic Disease Registry (PDF, 685KB)
5453	Application for Data for Evaluation and Planning Purposes from the Ministry of Health: Client Roster Information (Client Registry System / Enterprise Master Patient Index) (PDF, 537KB) Data Dictionary for HLTH 5453 (PDF, 57KB)
5454	Health Authority Application for Data for Evaluation and Planning Purposes from the Ministry of Health: National Ambulatory Care Reporting System (NACRS - Emergency Hospital Visits) (PDF, 573KB) Data Dictionary for HLTH 5454 (PDF, 66KB)
5500	Health Authority Application for Data Evaluation and Planning Purposes from the Ministry of Health: Surgical Patient Registry (PDF, 655KB) Data Dictionary for HLTH 5500 (PDF, 90KB)
5501	Health Authority Application for Data Evaluation and Planning Purposes from the Ministry of Health: Mental Health Services Data File (PDF, 557KB) Data Dictionary for HLTH 5501 (PDF, 70KB)
5502	Health Authority Application for Data Evaluation and Planning Purposes from the Ministry of Health: Home and Community Care Data File (PDF, 791KB) Data Dictionary for HLTH 5502 (PDF, 172KB)
5503	Health Authority Application for Data Evaluation and Planning Purposes from the Ministry of Health: Vital Statistics Birth File (January 1, 1986 onwards) (PDF, 582 KB)
5504	Health Authority Application for Data Evaluation and Planning Purposes from the Ministry of Health: Vital Statistics Stillbirths File (January 1, 1986 onwards) (PDF, 582KB)
5505	Health Authority Application for Data Evaluation and Planning Purposes from the Ministry of Health: Vital Statistics Deaths File (January 1, 1986 onwards) (PDF, 594KB)
5506	Project Closure (Confirmation of Data Disclosure) (PDF, 553KB)
5507	Submission for the Pre-Public Disclosure Review of Statistical and/or Research Materials (PDF, 541KB)
5508	Project Closure (Declaration of Project Withdrawal) (PDF, 520KB)
5509	Amendment Application (PDF, 524KB)
5510	Notification of Addition/Removal of Study Team Member(s) (PDF, 508KB)
5511	Health Authority Application for Data for Evaluation and Planning Purposes from the Ministry of Health: Health Systems Matrix (PDF, 618KB) Data Dictionary for HLTH 5511 (PDF, 135KB)
5512	Health Authority Application for Data for Evaluation and Planning Purposes from the Ministry of Health: Translation Master File – Postal Code Geocodes (PDF, 578KB) Data Dictionary for HLTH 5512 (PDF, 78KB)
5513	Health Authority Application for Data for Evaluation and Planning Purposes from the Ministry of Health: Residential Assessment Instrument (RAI) Data File Checklist (PDF, 1.5MB) Data Dictionary for HLTH 5513 (PDF, 238KB)
5514	Health Authority Application for Data for Evaluation and Planning Purposes from the Ministry of Health: Adjusted Clinical Group Information Checklist (PDF, 549KB)

Online Services & Data Request Forms

Medical Practice Access to PharmaNet Forms

Health Data Request Forms

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