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• Long Term Care and Community Support Program
• Medical Care Plan (MCP)
• Healthcare Providers
• Prescription Drug Program (NLPDP)
• Mental Health Care and Treatment Act
• Medical Assistance in Dying
• Health Promotions and Wellness

Note: all links below are PDFs and will open in a new window.

Long Term Care and Community Support Program

• Long Term Care and Community Support Program Adult Needs Assessment (152 KB)
• Long Term Care and Community Support Program Adult Needs Reassessment (60 KB)
• Reference Manual Long Term Care and Community Support Program Adult Needs Assessment (522 KB)

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Medical Care Plan (MCP)

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• Application for Newfoundland and Labrador Health Care Coverage (284 KB)
  • Demande de couverture pour services des soins de santé à Terre-Neuve-et-Labrador (486 KB)
• MCP Card Replacement/Information Update (113 KB)
  • Remplacement de la carte / mise à jour des renseignemen (373 KB)
• Newborn / Adopted Child Registration (33 KB)
  • Inscription des nouveau-nés et des enfants adoptés (143 KB)
• Application for Out-of-Province Coverage Certificate (28 KB)
  • Demande de certificat de couverture hors de la province (30 KB)
• Out of Province Claim (37 KB)
• Request for Release of Beneficiary Medical Care Plan (MCP) Number (28 KB)
• Request for Medical Claims History Information (85 KB)
• Dental Application Form (103 KB)
• Adult Dental Reimbursement Form (33 KB)

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Healthcare Providers

• Medical Care Plan (MCP) Assignment of Payment Agreement (67 KB)
• Medical Care Plan (MCP) Electronic Billing Application (761 KB)
• Medical Care Plan (MCP) Provider Registration Form (323 KB)
• Medical Care Plan (MCP) Provider Registration Form Completion Guide (223 KB)
• Medical Care Plan (MCP) Locum Documentation / Declaration (158 KB)
• Medical Care Plan (MCP) Provisionally Licensed Physicians Policy / Approval to Bill Fee for Service (167 KB)
• Medical Care Plan (MCP) Salaried Physician Request / Approval to Bill Temporary Fee for Service (683 KB)
• Rural Community Comprehensive Care Bonus – Application (654 KB)

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Prescription Drug Program (NLPDP)

Applications:

• 65 Plus Plan for Landed Immigrants (431 KB)
• Dental Application Form (103 KB)
• NLPDP Application Form(226 KB)

Consent:

• NLPDP Consent Form (60 KB)

Programme de médicaments sur ordonnance de Terre‑Neuve‑et‑Labrador (NLPDP)

Demandes :

• Régime 65 Plus Plan pour les immigrants reçus (104 ko)
• Formulaire de demande pour soins dentaires (103 ko)
• Formulaire de demande au titre du NLPDP (226 ko)

Consentement :

• Formulaire de consentement du NLPDP (60 ko)

Order Forms:

• Tamper Resistant Prescription Drug Pad Plan
  • Order Form for Prescribers (244 KB)
  • Order Form for Facility (242 KB)

Special Authorization Request Forms:

• Antiplatelet Therapy Form (402 KB)
• Anti-fibrotic Therapy (311 KB)
• Chronic Obstructive Pulmonary Disease (256 KB)
• Chronic Plaque Psoriasis Medications (258 KB)
• Ciprofloxacin Oral (177 KB)
• Diabetes Mellitus Type 2 High Cardiovascular Risk (62 KB)
• Duobrii (179 KB)
• Dupixent (315 KB)
• Hepatitis C Treatment Request (253 KB)
• HIV Pre-Exposure Prophylaxis (258 KB)
• Inflammatory Bowel Diseases (205 KB)
• Insulin Detemir (254 KB)
• LMWH for VTE Prevention Following Surgery (278 KB)
• Non-Insulin Anti-Diabetic Agents (288 KB)
• Ophthalmic VEG-F Inhibitor (284 KB)
• Phosphate Binders (379 KB)
• Rheumatoid Arthritis Medications- Initiation of Coverage (105 KB)
• Rheumatoid Arthritis Medications- Continuation of Coverage (69 KB)
• Standard Special Authorization Form
• Tamiflu for Long Term Care Residents (175 KB)
• Test Strips for Blood Glucose Monitoring (169 KB)

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Mental Health Care and Treatment Act

• Certificate of Involuntary Admission (323 KB)
• Certification Renewal (670 KB)
• Community Treatment Order (325 KB)
• Authorized Patient Pass (822 KB)
• Apprehension Conveyance Re Unauthorized Leave (717 KB)
• Notification CTO No Longer in Effect (200 KB)
• Order for the Apprehension Conveyance and Examination (219 KB)
• Authorization to Transfer to Another Psychiatric Unit (197 KB)
• Authorization to Transfer to Another Jurisdiction (197 KB)
• Authorization to Transfer into the Province (255 KB)
• Involuntary Certification Checklist (2 MB)
• Application for Review by the Mental Health Care and Treatment Review Board (222 KB)
• Community Treatment Order Checklist (1311 KB)

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Medical Assistance in Dying

• Medical Assistance in Dying MAiD Patient Request Record

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Health Promotions and Wellness

Community Healthy Living Fund

• Community Healthy Living Fund Final Report (620 KB)

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