Bulletin Number 4389	Date October 21, 2002	Direct inquiries to Ministry of Health and Long-Term Care Processing Office (See Address Below)
Distribution Physicians, Hospitals, Clinics, Laboratories

Subject

NEW FORMS FROM THE MINISTRY OF COMMUNITY, FAMILY AND CHILDREN’S SERVICES (MCFCS)

MCFCS (formerly known as Ministry of Community and Social Services) has three new forms for use in the Ontario Disability Support Program (ODSP): the Health Status Report and Activities of Daily Living Index (which replace the Health Status Report Form and Activities of Daily Living Form); the ODSP Mandatory Special Necessities Benefit Request Form and theODSP Special Diet Application Form.

As of October 1, 2002, the descriptions and fee values for the MCFCS ODSP codes in Appendix F to the Schedule of Benefits have been changed to the following:

K050	Health Status Report and Activities of Daily Living Index (completion of amalgamated forms)	$100.00
K051	Health Status Report (completed separately)	$80.00
K052	Activities of Daily Living Index (completed separately)	$20.00
K054	Mandatory Special Necessities Benefit Request Form	$25.00
K055	Special Diet Application Form	$20.00

NOTE :  Assessments using the old Health Status Report and Activities of Daily Living Form may still be submitted for payment.

INQUIRIES :  Physicians should direct inquiries regarding MCFCS forms and their use to the local MCFCS, rather than MOHLTC.

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Office locations
Barrie 30 Poyntz St. L4M 3P2	Hamilton 119 King St. W P.O. Box 2280, Stn. A L8N 4C8	Kenora 220-808 Robertson St. P9N 1X9	Kingston 1055 Princess St. P.O. Box 9000 K7L 5A9	Kitchener Canada Life Square Main Floor 235 King St. E., N2G 4N5	London 217 York St., 5th FloorP.O. Box 5700 Terminal A N6A 1B7	Mississauga 201 City Centre Dr. P.O. Box 7020, Stn. A L5A 3M1
North Bay 101-447 McKeown St. P1B 9S9	Oshawa Exec. Tower, Oshawa Centre. 419 King St. W. P.O. Box 635 L1H 8L4	Ottawa Fuller Building 75 Albert Street K1P 5Y9	Owen Sound 981 2nd Avenue E. N4K 2H5	Peterborough 550 Lansdowne St. W. K9J 8J8	St.Catharines 59 Church St 3rd Floor L2R 3C3	Sarnia 452 Christina St. N. N7T 5W4
Sault Ste. Marie Roberta Bondar Place 70 Foster Dr., Ste. 100 P6A 6V4	Sudbury 199 Larch St., Suite 801 P3E 5R1	Thunder Bay 435 James St. S. , Suite 113 P7E 6T1	Timmins 38 Pine St. N., Ste. 110 P4N 6K6	Toronto 2195 Yonge St. P.O Box 1700 Stn. A M5W 1G9	Windsor 1427 Ouellette Ave. N8X 1K1	Head Office P.O. Box 38 Kingston, ON K7L 5J2