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Application for Determination of Eligibility for LTC
Instructions
Form provided by the Ministry of Long-Term Care under the Fixing Long-Term Care Act, 2021.
If you wish to be admitted to a long-term care (LTC) home, you must fill out this form. This information is required by Ontario Health atHome, the designated placement co-ordinator for LTC homes, to determine if you are eligible for admission. Ontario Health atHome may collect additional personal health information from your health care providers for the purpose of determining your eligibility. Ontario Health atHome may also use and disclose the information for the same purpose.
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