Get Ohip 0005 (rev 9/07)

The OHIP 0005 (Rev 9/07) is a vital form used to report medical disabilities in children. This guide will help you navigate the process of completing the form online, ensuring all necessary information is provided accurately and efficiently.

Follow the steps to successfully complete the OHIP 0005 form

1. Press the ‘Get Form’ button to access the OHIP 0005 (Rev 9/07) document and open it in your preferred online editor.
2. Begin by filling out the child's name in the designated field. Ensure that the name is spelled correctly to avoid any processing delays.
3. Enter the agency's name and address, providing all necessary details such as street address, city, state, and postal code.
4. Indicate the child's sex by selecting either 'M' for male or 'F' for female, as well as entering the date of birth in the specified format.
5. Add the telephone number and case number in the respective fields to maintain proper communication and case identification.
6. In the section for 'Dates of Treatment', fill in the first and last treatment dates, including the frequency of treatment.
7. Provide the diagnosis or diagnoses in the corresponding field to ensure accurate medical reporting.
8. Offer a detailed history, including the date(s) of diagnosis and earliest symptoms. This section should capture the etiology of the impairment, initial physical examination findings, treatment received, and the child's subsequent medical course.
9. Document the findings from the last examination, including the date of examination, height, weight, blood pressure, pulse, and any pertinent physical findings.
10. Assess and note whether the child’s function or behavior is age-appropriate across various skills such as fine/gross motor, sensory abilities, communication, cognitive, and social/emotional skills. Include actual age levels and observations.
11. Provide your signature, print your name, and include your specialty if applicable. Additionally, enter your office address, telephone number, and the date signed.
12. Once all sections are complete, you can save your changes, download the completed form, print it for records, or share it if necessary.

Complete your OHIP 0005 (Rev 9/07) form online today for efficient processing.