This section provides practice resources for NPs. The information is intended to complement the Nurse Practitioner practice standard. The College is not responsible for information provided by external organizations.
Ordering Laboratory and Diagnostic Tests
Provider Services Number
When ordering tests, NPs must include their provider services identification number on the requisition. This number authorizes the laboratory or diagnostic facility to bill the Ontario Health Insurance Plan (OHIP) for the tests. For more information or to obtain a provider services identification number, contact the Ministry at 1 800 268-1154 (416 314-5518 in Toronto) or visit OHIP’s website to download the Registration for Regulated Health Professions form (No. 3384-83).
Clinical laboratory practice is guided by stringent quality management principles that are in place to ensure clients receive the most reliable, high-quality test results. Many quality issues that result in a laboratory's rejection of a specimen can be resolved through upfront communication between the provider ordering the test and the local laboratory.
NPs who have questions about laboratory policies and procedures for ordering tests and procuring, labeling, storing and transporting samples are encouraged to consult the laboratory prior to ordering the test to mitigate the risk of specimen rejection and delays in client care. For further information, refer to the Ontario Association of Medical Laboratories' Guidelines for the Rejection of Specimens.
Applying Forms of Energy
NPs are not authorized to apply a form of energy until the Ontario government creates a regulation to enable this practice. In the meantime, NPs can apply forms of energy if delegated to do so by an individual authorized under the Regulated Health Professions Act, 1991. More information about forms of energy in the context of nursing practice is available here.
Prescribing and Ontario Drug Programs
Ontario Drug Benefit (ODB) Program
The Ontario Drug Benefit Program (ODB) provides drug benefits for eligible Ontarians. Prescriptions written by NPs and dispensed in Ontario are ODB-eligible. NPs must include their College registration number on prescriptions.
NPs who prescribe medications to ODB-eligible clients must have a provider services identification number. Although this number is not required on the prescription, it is used by the Ministry when adjudicating claims. For more information, or to obtain a provider services number, contact the Ministry at 1 800 268-1154 (416 314-5518 in Toronto) or visit OHIP's website to download the Registration for Regulated Health Professions form (No. 3384-83).
The ODB formulary is regularly updated and published. Information about ODB and other Ontario public drug programs is available from the Ministry of Health and Long-Term Care.
Limited Use Drugs
NPs may prescribe a limited use drug if the client satisfies ODB-listed limited use criteria, and the NP writes the limited use code on the prescription. Limited use prescriptions must include a Limited Use/Nutrition Product Form that indicates the reason for use. More information about limited use drugs is available on the Ministry’s website.
Exceptional Access Program (EAP)
ODB cannot accept an NP prescription under the EAP because the Ontario Drug Benefit Act limits this authority to physicians only. However, ODB will reimburse clients when an NP renews the prescription if a physician provided the initial prescription under the EAP. More information about the EAP is available on the Ministry's website.
Nutrition and Diabetes Supplies
NPs can prescribe nutrition products and diabetes management supplies. Nutrition products and diabetic testing agents are included in the ODB formulary.
Special Access Program
Health Canada’s Special Access Program (SAP) allows practitioners to request access to drugs that are unavailable for sale in Canada. This access is limited to clients with serious or life-threatening conditions on a compassionate or emergency basis, when conventional therapies have failed, are unsuitable, or are unavailable. NPs may request access to medications that they are legally authorized to prescribe through the SAP. More information about the SAP, and requirements that practitioners must meet, is available on Health Canada’s website.
Facilitating Access to Personal Supports
Assistive Devices Program (ADP)
The ADP helps eligible Ontarians with long-term physical disabilities access and pay for personalized assistive devices. The Ministry accepts NP authorization forms for several devices and supplies. For more information on the type of devices and the circumstances in which NPs can complete authorization forms, call the Ministry at 1 800 268-6021 (416-327-8804 in Toronto) or visit the Ministry website.
Hospital Equipment for Out-Patients
When the equipment and supplies are available in a hospital and prescribed for a client by either an NP employed by the hospital, or an NP who has privileges at the hospital, OHIP covers the costs of:
- home renal dialysis equipment/supplies
- home hyperalimentation equipment and supplies, and
- haemophilia-related equipment/supplies.
Ontario Disability Support Program (ODSP)
ODSP provides income and employment support to eligible Ontarians. When assessing an individual’s eligibility for income support, ODSP accepts an NP’s assessment of a client’s physical or mental impairment and the expected duration of that impairment. As well, NPs can complete an application for a special diet allowance for eligible recipients. For more information about ODSP, visit the Ministry's website.
Workplace Safety and Insurance Board (WSIB)
The Workplace Safety and Insurance Board (WSIB) recognizes NPs as service providers. To bill WSIB, NPs must obtain a WSIB provider identification number, available by calling WSIB at 416 344-4526 or 1 800 569-7919, or by completing this online form (No. 189OA)
When NPs refer eligible Ontarians to hospital outpatient clinics, OHIP covers the costs of occupational, physiotherapy and speech therapy services. NPs can also refer clients to community rehabilitation clinics; however, financial coverage for the client is subject to third-party insurance policies.
NPs who are employees of a hospital are authorized to order diagnostics and treatments for hospital patients (in-patients and out-patients). NPs who are not hospital employees may apply to the hospital for these privileges. For further information about the tests, medications and procedures that NPs can order and/or perform, and the applicable standards, see the Nurse Practitioner practice standard.
Regulation 965 under the Public Hospitals Act specifies that the hospital’s Medical Advisory Committee (MAC) can make recommendations to the hospital board regarding appointing and granting privileges to NPs who are not hospital employees. The hospital’s MAC is responsible for making recommendations to the hospital board related to the overall supervision and quality of the practice of NPs who are not hospital employees, but have been granted hospital privileges.
Admitting and Discharging Clients
NPs are authorized to admit and discharge hospital patients. The process for an NP to admit and discharge clients is up to the discretion of the hospital. An NP should always consult with the facility for further information on its policies.
Public Health Reporting
Under the Health Protection and Promotion Act, NPs have a duty to report certain diseases to the medical officer of health in their local public health unit, if they suspect or know that a person has that disease, or may be infected with an agent of a communicable disease.
The Ministry of Health has a list of the local public health units in Ontario and their locations.
For a list of reportable diseases and infectious agents in Ontario and instructions on reporting, contact your local public health unit.
Reporting to the local public health unit
In facilities (such as, hospital, long-term-care home, home for special care, correctional institution), it is the employer's responsibility to report diseases or infectious agents among clients. Therefore facilities should have policies and procedures on how the reporting mechanism will take place.
In addition, NPs have a duty to report when a client refuses or neglects treatment for a communicable disease. A report containing the client’s name and address should be made to the medical officer of health in their local public health units.
If an NP certifies death where a communicable disease was either a cause or contributing factor of the client’s death, this information must be reported to the local public health unit. For information about the circumstances in which NPs are authorized to certify death, see Issuing Medical Certificates of Death (below).
An NP who has information about any animal bite or other animal to human contact that may result in rabies must report the information to the local medical officer of health as soon as possible.
Issuing Medical Certificates of Death
The provincial Vital Statistics Act gives NPs the authority to complete a Medical Certificate of Death (Form 16) in specific circumstances. This certificate is part of the death registration form and is an important legal document detailing the fact and circumstances of death. NPs can complete a Medical Certificate of Death of the deceased when:
- the NP had primary responsibility for the deceased’s care
- the death was expected
- a documented medical diagnosis of a terminal disease had been made by a medical practitioner
- there was a predictable pattern of decline, and
- no unexpected events or complications arose.
An NP had primary responsibility for the deceased’s care when she or he had an established therapeutic nurse-client relationship with the client and provided care to the client either independently or as a member of a team of health care providers. NPs should not sign the Medical Certificate of Death for clients they did not care for, did not have contact with or did not know.
Unexpected events or complications that arose during the last illness of the deceased include death caused by an accident such as a fall or an unanticipated adverse drug reaction.
When NPs are unsure if the circumstances surrounding the death of the client were unexpected, they must consult with a physician.
Prior to signing a Medical Certificate of Death, NPs must read and follow the instructions in the Handbook on Medical Certification of Death published by the Office of the Registrar General. The expectations outlined in the handbook apply in all circumstances, including deaths that have occurred in hospital.
If the death has occurred in a hospital and is a coroner’s case, and the coroner does not provide the NP with a copy of the medical certificate of death, the NP is required to complete the Certificate of Death Form (see Regulation 965 of the Public Hospitals Act.)
Working with Physicians with Restricted Licences
NPs may work with physicians who have restricted licences. For example, international medical graduates or physicians in the process of obtaining certification may have a restricted licence. The terms and conditions of the restrictions are specific to each physician.
Physicians with a restricted licence are fully qualified to practise medicine, but are responsible for practising within any terms, conditions and limitations that the College of Physicians and Surgeons of Ontario has placed on their practice. They are also responsible for determining any individual liability issues that may arise.
NPs can consult with, or refer to, a physician whose licence is restricted and are not responsible for interpreting any terms, conditions or limitations on a physician’s practice.
Immunization of School Pupils
Under the Immunization of School Pupils Act, NPs are authorized to complete a statement of medical exemption that exempts a child from a childhood immunization required for school attendance in Ontario. The conditions under which an exemption may be provided are:
- the immunization may be detrimental to the health of the client (i.e., the child is known to be allergic to a substance in the vaccine), or
- the immunization is unnecessary because the client is already immune (i.e., there is laboratory evidence of immunity).
Under the Health Protection and Promotion Act, NPs have a duty to report to the medical officer of health in their local public health unit, any of the following reactions to an immunizing agent:
a) Persistent crying or screaming, anaphylaxis or anaphylactic shock within 48 hours after immunization
b) Shock-like collapse, high fever or convulsions within 3 days after immunization
c) Arthritis within 42 days of immunization
d) Generalized urticaria, residual seizure disorder, encephalopathy or any other significant occurrence within 15 days of immunization
e) Death occurring at any time or death following any of the above.
These reactions are considered reportable events. NPs must make the report within 7 days of forming an opinion that a client has, or may have, experienced any of the above reactions related to immunization.
In addition, when health care workers are obtaining consent for immunizations, they must provide education to clients about the importance of immediately reporting to a physician or NP, any reaction that might be a reportable event.
Responding to Emergencies
Emergency Infection Kits for NPs
The Ontario Ministry of Health and Long-Term Care offers eligible NPs an emergency infection control kit.
The kits can be used to provide the first line of defence during a large-scale infectious disease outbreak, such as an influenza pandemic. It is designed particularly for settings that do not have everyday access to infection control supplies and equipment. The Ministry recommends that all health care facilities and services maintain a one-month supply of personal protective equipment.
To receive a kit, an NP must:
- be in good standing with the College
- practise in a setting that is not directly affiliated with or located in a hospital, long-term care facility, family health clinic or correctional facility, and
- practise in a setting that is not located in the same office with a physician who previously received a kit.
To view the order form, visit www.health.gov.on.ca/login and enter the password regeick08 for English, and regeickf08 for French.
Completing Transportation-Related Forms
NPs can complete the Application for Accessible Parking Permit form (SRLV-129 07-08) for clients. The form is available on the Ministry of Transportation website and at any ServiceOntario driver and vehicle licence issuing office.
Commercial Licence Medical Report
NPs can complete the Commercial Licence Medical Report form (i.e., drivers’ physical). For further information, visit the Medical Review Section (Commercial Drivers) of the Ministry of Transportation website.
Fitness to Drive Medical Reports
The Ministry of Transportation has a series of “condition-specific” medical forms that it provides to people who have been reported as having a medical condition that may make it dangerous for them to drive.
The initial medical condition report about a person’s fitness to drive is usually completed by a physician. NPs' clients may ask them to complete a follow-up condition-specific assessment and form. There are several forms for conditions such as substance use disorders, sleep disorders, cognitive impairment and so on. For more information, visit the Medical Review Section of the Ministry of Transportation website.
Caring for Clients after Endoluminal Vein Dilation Procedures
The Ontario Multiple Sclerosis (MS) Expert Advisory Group has developed guidelines for health care practitioners who provide post-operative care and ongoing follow-up care for MS patients who have returned to Ontario after an endoluminal vein dilation procedure for the treatment of MS in another country. The guidelines are also designed to educate people about the follow-up care that MS patients can expect from their health care practitioner in Ontario.
Read the Ministry report and the Ontario Multiple Sclerosis (MS) Expert Advisory Group’s guidelines.