|Classification / Identification:|
| ||Form Number:||014-2743-84||Edition date: ||2008/02 |
| ||Title:||Request for Approval of Payment for Proposed Dental Procedures|
| ||Ministry:||Health|| || |
| ||Branch/ABC:||Claim Services Branch|| || |
| ||Program:||Claims Services|| || |
| ||Purpose of Form:||form completed to obtain approval for dental procedures to be carried out in hospital and covered by OHIP|| || |
| ||Ordering Information:||Submit completed order request form (form # 014-0350-93) to OSSDistribution@ontario.ca (preferred option) or fax to 416-679-8192.|
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