Ordering IG in Ontario
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
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
Version 5.0 January 2018
Ontario MOHLTC IG Request Form Neurology
Version 3.0 January 2018
Ontario MOHLTC IG Request Form for Neurology – fillable
Version 3.0 January 2018