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Ordering IG in Ontario

Use of the MOHLTC IG Request Form

Use of the MOHLTC IG Request Form

This document provides information on use of the MOHLTC  IG Request Forms and a description of the responsibilities of healthcare professionals involved in the ordering process

Ontario MOHLTC IG Request Form Non-Neurology

Ontario MOHLTC IG Request Form Non-Neurology

A standardized request form that references the 2018 Ontario IG Utilization Management Guidelines. Version 5.0 January 2018 Please note: This form is to be used for non-neurology indications ONLY

Ontario MOHLTC IG Request Form Non-Neurology-fillable

Ontario MOHLTC IG Request Form Non-Neurology-fillable

Version 5.0 January 2018

Ontario MOHLTC IG Request Form Neurology

Ontario MOHLTC IG Request Form Neurology

Version 3.0 January 2018

Ontario MOHLTC IG Request Form for Neurology – fillable

Ontario MOHLTC IG Request Form for Neurology – fillable

Version 3.0 January 2018