Newfoundland and Labrador Department of Health and Community Services Forms
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Form MHCTA-01 "First Certificate of Involuntary Admission" - Newfoundland and Labrador, Canada
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Form MHCTA-06 "Order for the Apprehension and Conveyance of an Involuntary Patient Due to Unauthorized Leave" - Newfoundland and Labrador, Canada
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Form MHCTA-05 "Authorized Patient Pass" - Newfoundland and Labrador, Canada
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Form MHCTA-02 "Certificate of Renewal" - Newfoundland and Labrador, Canada
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Form MHCTA-08 "Order for the Apprehension, Conveyance and Examination of a Person Who Failed to Comply to Community Treatment Order (Cto)" - Newfoundland and Labrador, Canada
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Form MHCTA-07 "Notification Advising a Person That a Community Treatment Order Is No Longer in Effect" - Newfoundland and Labrador, Canada
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Form MHCTA-03 "Community Treatment Order" - Newfoundland and Labrador, Canada
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Form MHCTA-10 "Authorization to Transfer to Another Jurisdiction" - Newfoundland and Labrador, Canada
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Form MHCTA-11 "Authorization to Transfer Into the Province" - Newfoundland and Labrador, Canada
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Form MHCTA-13 "Application / Withdrawal of Application for Review by the Mental Health Care and Treatment Review Board" - Newfoundland and Labrador, Canada
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Form MHCTA-09 "Authorization to Transfer to Another Psychiatric Unit" - Newfoundland and Labrador, Canada
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Form MHCTA-14 "Community Treatment Order (Cto) Checklist" - Newfoundland and Labrador, Canada
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Form MHCTA-12 "Involuntary Certification / Communications Checklist" - Newfoundland and Labrador, Canada
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Form MEF-19A "Oath or Affirmation of Campaign Contributions Disclosure Where Individual Contributions (Money, Goods or Services) Exceeded $100.00" - Newfoundland and Labrador, Canada
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"Special Authorization Request Form - Sevelamer" - Newfoundland and Labrador, Canada
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"Special Authorization Request Form - Request for Coverage of Chronic Obstructive Pulmonary Disease (Copd) Therapy" - Newfoundland and Labrador, Canada
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"Special Authorization Request Form - Request for Coverage Hepatitis C Treatments" - Newfoundland and Labrador, Canada
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"Special Authorization Request Form - Diabetes Mellitus Type 2 High Cardiovascular Risk" - Newfoundland and Labrador, Canada
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"Special Authorization Request Form - Request for Coverage of Novel Oral Anticoagulant (Noac) for Atrial Fibrillation (AF)" - Newfoundland and Labrador, Canada
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"Special Authorization Request Form - Request for Coverage for Oseltamivir for Long Term Care Residents" - Newfoundland and Labrador, Canada
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"Special Authorization Request Form - Request for Coverage for Emtricitabine/Tenofovir Disoproxil Fumarate for Prep" - Newfoundland and Labrador, Canada
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"Electronic Billing Application" - Newfoundland and Labrador, Canada
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"Special Authorization Request Form - Levemir (Insulin Detemir)" - Newfoundland and Labrador, Canada
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"Special Authorization Request Form - Venous Thromboembolism (Vte) Prevention Following Surgery" - Newfoundland and Labrador, Canada
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"Special Authorization Request Form - Biologic Therapy for Inflammatory Bowel Disease" - Newfoundland and Labrador, Canada
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"Idiopathic Pulmonary Fibrosis Treatment Request Form" - Newfoundland and Labrador, Canada
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"Special Authorization Request Form - Sevelamer (Renagel)" - Newfoundland and Labrador, Canada
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"Special Authorization Request Form - Methadone Maintenance Treatment: Daily Dispensing" - Newfoundland and Labrador, Canada
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"Special Authorization Request Form - Methadone Maintenance Treatment: Take-Home Doses" - Newfoundland and Labrador, Canada
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"Special Authorization Request Form - Biologic Therapy for Chronic Plaque Psoriasis" - Newfoundland and Labrador, Canada
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"Rheumatoid Arthritis Medications - Continuation of Coverage" - Newfoundland and Labrador, Canada
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"Special Authorization Request Form - Ticagrelor (Brilinta)" - Newfoundland and Labrador, Canada
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"Request for Tamper Resistant Prescription Pads (Facility)" - Newfoundland and Labrador, Canada
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"Request for Tamper Resistant Prescription Pads" - Newfoundland and Labrador, Canada
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Appendix IV "Case Report Form (Hospitalizations, Deaths, Sris)" - Newfoundland and Labrador, Canada
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"Dental Application Form" - Newfoundland and Labrador, Canada
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"Invasive Group a Streptococcal Disease (Streptococcus Pyogenes) Case Report Form" - Newfoundland and Labrador, Canada
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"Special Authorization Request Form - Request for Coverage of Blood Glucose Test Strips" - Newfoundland and Labrador, Canada
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"Special Authorization Request Form - Initiation of Coverage of Restricted Rheumatoid Arthritis Medications" - Newfoundland and Labrador, Canada
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"Out-Of-Province Claim" - Newfoundland and Labrador, Canada
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![Form MHCTA-01 "First Certificate of Involuntary Admission" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/1873/18733/1873323/form-mhcta-01-first-certificate-of-involuntary-admission-newfoundland-and-labrador-canada.png "Form MHCTA-01 "First Certificate of Involuntary Admission" - Newfoundland and Labrador, Canada")
![Form MHCTA-06 "Order for the Apprehension and Conveyance of an Involuntary Patient Due to Unauthorized Leave" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/1873/18733/1873327/form-mhcta-06-order-for-the-apprehension-and-conveyance-of-an-involuntary-patient-due-to-unauthorized-leave-newfoundland-and-labrador-canada.png "Form MHCTA-06 "Order for the Apprehension and Conveyance of an Involuntary Patient Due to Unauthorized Leave" - Newfoundland and Labrador, Canada")
![Form MHCTA-05 "Authorized Patient Pass" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/1873/18733/1873328/form-mhcta-05-authorized-patient-pass-newfoundland-and-labrador-canada.png "Form MHCTA-05 "Authorized Patient Pass" - Newfoundland and Labrador, Canada")
![Form MHCTA-02 "Certificate of Renewal" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/1873/18733/1873325/form-mhcta-02-certificate-of-renewal-newfoundland-and-labrador-canada.png "Form MHCTA-02 "Certificate of Renewal" - Newfoundland and Labrador, Canada")
![Form MHCTA-08 "Order for the Apprehension, Conveyance and Examination of a Person Who Failed to Comply to Community Treatment Order (Cto)" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/1873/18733/1873329/form-mhcta-08-order-for-the-apprehension-conveyance-and-examination-of-a-person-who-failed-to-comply-to-community-treatment-order-cto-newfoundland-and-labrador-canada.png "Form MHCTA-08 "Order for the Apprehension, Conveyance and Examination of a Person Who Failed to Comply to Community Treatment Order (Cto)" - Newfoundland and Labrador, Canada")
![Form MHCTA-07 "Notification Advising a Person That a Community Treatment Order Is No Longer in Effect" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/1873/18733/1873326/form-mhcta-07-notification-advising-a-person-that-a-community-treatment-order-is-no-longer-in-effect-newfoundland-and-labrador-canada.png "Form MHCTA-07 "Notification Advising a Person That a Community Treatment Order Is No Longer in Effect" - Newfoundland and Labrador, Canada")
![Form MHCTA-03 "Community Treatment Order" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/1873/18733/1873335/form-mhcta-03-community-treatment-order-newfoundland-and-labrador-canada.png "Form MHCTA-03 "Community Treatment Order" - Newfoundland and Labrador, Canada")
![Form MHCTA-10 "Authorization to Transfer to Another Jurisdiction" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/1873/18733/1873332/form-mhcta-10-authorization-to-transfer-to-another-jurisdiction-newfoundland-and-labrador-canada.png "Form MHCTA-10 "Authorization to Transfer to Another Jurisdiction" - Newfoundland and Labrador, Canada")
![Form MHCTA-11 "Authorization to Transfer Into the Province" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/1873/18733/1873333/form-mhcta-11-authorization-to-transfer-into-the-province-newfoundland-and-labrador-canada.png "Form MHCTA-11 "Authorization to Transfer Into the Province" - Newfoundland and Labrador, Canada")
![Form MHCTA-13 "Application / Withdrawal of Application for Review by the Mental Health Care and Treatment Review Board" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/1873/18733/1873334/form-mhcta-13-application-withdrawal-of-application-for-review-by-the-mental-health-care-and-treatment-review-board-newfoundland-and-labrador-canada.png "Form MHCTA-13 "Application / Withdrawal of Application for Review by the Mental Health Care and Treatment Review Board" - Newfoundland and Labrador, Canada")
![Form MHCTA-09 "Authorization to Transfer to Another Psychiatric Unit" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/1873/18733/1873331/form-mhcta-09-authorization-to-transfer-to-another-psychiatric-unit-newfoundland-and-labrador-canada.png "Form MHCTA-09 "Authorization to Transfer to Another Psychiatric Unit" - Newfoundland and Labrador, Canada")
![Form MHCTA-14 "Community Treatment Order (Cto) Checklist" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/2031/20318/2031855/form-mhcta-14-community-treatment-order-cto-checklist-newfoundland-and-labrador-canada.png "Form MHCTA-14 "Community Treatment Order (Cto) Checklist" - Newfoundland and Labrador, Canada")
![Form MHCTA-12 "Involuntary Certification / Communications Checklist" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/2031/20318/2031854/form-mhcta-12-involuntary-certification-communications-checklist-newfoundland-and-labrador-canada.png "Form MHCTA-12 "Involuntary Certification / Communications Checklist" - Newfoundland and Labrador, Canada")
![Form MEF-19A "Oath or Affirmation of Campaign Contributions Disclosure Where Individual Contributions (Money, Goods or Services) Exceeded $100.00" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/1873/18733/1873379/form-mef-19a-oath-or-affirmation-of-campaign-contributions-disclosure-where-individual-contributions-money-goods-or-services-exceeded-100-00-newfoundland-and-labrador-canada.png "Form MEF-19A "Oath or Affirmation of Campaign Contributions Disclosure Where Individual Contributions (Money, Goods or Services) Exceeded $100.00" - Newfoundland and Labrador, Canada")
!["Special Authorization Request Form - Sevelamer" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/2066/20668/2066816/special-authorization-request-form-sevelamer-newfoundland-and-labrador-canada.png ""Special Authorization Request Form - Sevelamer" - Newfoundland and Labrador, Canada")
!["Special Authorization Request Form - Request for Coverage of Chronic Obstructive Pulmonary Disease (Copd) Therapy" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/2031/20318/2031846/special-authorization-request-form-request-for-coverage-of-chronic-obstructive-pulmonary-disease-copd-therapy-newfoundland-and-labrador-canada.png ""Special Authorization Request Form - Request for Coverage of Chronic Obstructive Pulmonary Disease (Copd) Therapy" - Newfoundland and Labrador, Canada")
!["Special Authorization Request Form - Request for Coverage Hepatitis C Treatments" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/2011/20111/2011125/special-authorization-request-form-request-for-coverage-hepatitis-c-treatments-newfoundland-and-labrador-canada.png ""Special Authorization Request Form - Request for Coverage Hepatitis C Treatments" - Newfoundland and Labrador, Canada")
!["Special Authorization Request Form - Diabetes Mellitus Type 2 High Cardiovascular Risk" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/2031/20318/2031844/special-authorization-request-form-diabetes-mellitus-type-2-high-cardiovascular-risk-newfoundland-and-labrador-canada.png ""Special Authorization Request Form - Diabetes Mellitus Type 2 High Cardiovascular Risk" - Newfoundland and Labrador, Canada")
!["Special Authorization Request Form - Request for Coverage of Novel Oral Anticoagulant (Noac) for Atrial Fibrillation (AF)" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/2031/20318/2031848/special-authorization-request-form-request-for-coverage-of-novel-oral-anticoagulant-noac-for-atrial-fibrillation-af-newfoundland-and-labrador-canada.png ""Special Authorization Request Form - Request for Coverage of Novel Oral Anticoagulant (Noac) for Atrial Fibrillation (AF)" - Newfoundland and Labrador, Canada")
!["Special Authorization Request Form - Request for Coverage for Oseltamivir for Long Term Care Residents" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/1873/18733/1873321/special-authorization-request-form-request-for-coverage-for-oseltamivir-for-long-term-care-residents-newfoundland-and-labrador-canada.png ""Special Authorization Request Form - Request for Coverage for Oseltamivir for Long Term Care Residents" - Newfoundland and Labrador, Canada")
!["Special Authorization Request Form - Request for Coverage for Emtricitabine/Tenofovir Disoproxil Fumarate for Prep" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/1873/18733/1873316/special-authorization-request-form-request-for-coverage-for-emtricitabine-tenofovir-disoproxil-fumarate-for-prep-newfoundland-and-labrador-canada.png ""Special Authorization Request Form - Request for Coverage for Emtricitabine/Tenofovir Disoproxil Fumarate for Prep" - Newfoundland and Labrador, Canada")
!["Electronic Billing Application" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/1873/18733/1873305/electronic-billing-application-newfoundland-and-labrador-canada.png ""Electronic Billing Application" - Newfoundland and Labrador, Canada")
!["Special Authorization Request Form - Levemir (Insulin Detemir)" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/1873/18733/1873313/special-authorization-request-form-levemir-insulin-detemir-newfoundland-and-labrador-canada.png ""Special Authorization Request Form - Levemir (Insulin Detemir)" - Newfoundland and Labrador, Canada")
!["Special Authorization Request Form - Venous Thromboembolism (Vte) Prevention Following Surgery" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/1873/18733/1873322/special-authorization-request-form-venous-thromboembolism-vte-prevention-following-surgery-newfoundland-and-labrador-canada.png ""Special Authorization Request Form - Venous Thromboembolism (Vte) Prevention Following Surgery" - Newfoundland and Labrador, Canada")
!["Special Authorization Request Form - Biologic Therapy for Inflammatory Bowel Disease" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/1873/18733/1873312/special-authorization-request-form-biologic-therapy-for-inflammatory-bowel-disease-newfoundland-and-labrador-canada.png ""Special Authorization Request Form - Biologic Therapy for Inflammatory Bowel Disease" - Newfoundland and Labrador, Canada")
!["Idiopathic Pulmonary Fibrosis Treatment Request Form" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/1873/18733/1873310/idiopathic-pulmonary-fibrosis-treatment-request-form-newfoundland-and-labrador-canada.png ""Idiopathic Pulmonary Fibrosis Treatment Request Form" - Newfoundland and Labrador, Canada")
!["Special Authorization Request Form - Sevelamer (Renagel)" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/1873/18733/1873320/special-authorization-request-form-sevelamer-renagel-newfoundland-and-labrador-canada.png ""Special Authorization Request Form - Sevelamer (Renagel)" - Newfoundland and Labrador, Canada")
!["Special Authorization Request Form - Methadone Maintenance Treatment: Daily Dispensing" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/1873/18733/1873314/special-authorization-request-form-methadone-maintenance-treatment-daily-dispensing-newfoundland-and-labrador-canada.png ""Special Authorization Request Form - Methadone Maintenance Treatment: Daily Dispensing" - Newfoundland and Labrador, Canada")
!["Special Authorization Request Form - Methadone Maintenance Treatment: Take-Home Doses" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/1873/18733/1873319/special-authorization-request-form-methadone-maintenance-treatment-take-home-doses-newfoundland-and-labrador-canada.png ""Special Authorization Request Form - Methadone Maintenance Treatment: Take-Home Doses" - Newfoundland and Labrador, Canada")
!["Special Authorization Request Form - Biologic Therapy for Chronic Plaque Psoriasis" - Newfoundland and Labrador, Canada](https://data.templateroller.com/pdf_docs_html/1873/18733/1873309/special-authorization-request-form-biologic-therapy-for-chronic-plaque-psoriasis-newfoundland-and-labrador-canada.png ""Special Authorization Request Form - Biologic Therapy for Chronic Plaque Psoriasis" - Newfoundland and Labrador, Canada")
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