|Classification / Identification:|
| ||Form Number:||014-4931-87E||Edition date: ||2022/07 |
| ||Title:||Annual Deductible Re-Assessment Request|
| ||Ministry:||Health|| || |
| ||Branch/ABC:||Drug Programs Delivery Branch|| || |
| ||Program:||Ontario Drug Benefit|| || |
| ||Purpose of Form:||MOH form for Trillium Drug Program (TDP) Households to request a re-assessment of their TDP Household's deductible.|| || |
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