Forms
Use this order form for the From the Ground Up fundraiser for early learning centres.
This form is for Yukon families or individuals to apply to be a caregiver to a Yukon child.
This form can allow a patient to request medical assistance in dying. It should be given to a doctor or nurse practitioner.
Health care providers use this form to refer your patients to the Chronic Conditions Support Program. These include: Your Health! Your Way!; Diabetes Wellness Series; supervised exercise; and Pulmonary Rehabilitation Program.
This form is for someone from your health-care team to fill out. It's needed to enter a continuing care facility or community day program in Yukon.
This form is for someone from your health-care team to fill out. It's needed to enter hospice in a continuing care facility in Yukon.
This is the form to fill out if you are a health professional reporting an exposure incident for blood and body fluids.
This is the follow up letter form for health professionals to fill out in the event of blood or body fluid exposure.
Fill out this form to obtain adoption records in Yukon.
A doctor fills out this form after they finish a patient's mental health examination.
Fill out this application form to get or find a birth, marriage or death certificate issued in the Yukon. Mail or bring this form to the Vital Statistics office in Whitehorse. Find out more about birth certificates.
Complete the Yukon Health Care Insurance Plan notification of extended absence form if you'll be away from Yukon for 6 months or more. Drop off this form at insured health services.
Fill out this form once you have returned from an extended absence from Yukon for 6 months or more. Drop off this form at insured health services.
You can use this form to apply for case management and outreach supports for housing and community outreach services. This applies to you if you: are homeless, or have a history of homelessness and/or housing instability; have complex... more
Fill out this form if you're no longer eligible for financial help due to your income. If this applies to you, talk to your social worker about transitional support. Give this form to your social worker.
Use this out-of-country claims form to provide information for travel insurance or extended health benefits to make a health care insurance claim for services provided outside of Canada.
A physician uses this form. It confirms that a mother allows the collection of medical and personal information about her fetus's birth defect.
Environmental Health Services uses this form to document follow-up information on reported instances of rabies exposure. This information is sent to the medical officer of health and the chief veterinary officer.
Use the disclosure veto and statement if you're an adopted person or birth parent. This form stops the sharing of information from: a birth certificate; or related adoption records.
Municipalities, First Nations, Government of Yukon, and other businesses or organizations use this form to apply for a permit for a trucked drinking water distribution system. Environmental Health Services ensures that trucked water meets... more
A person who makes a directive under the Care Consent Act submits this form. They have a lawyer complete the form. It certifies that the lawyer was consulted about the application of Section 30 of the Act. Form 1 of Care Consent Act,... more
A health care provider fills out this form. It declares that a person in care cannot make reasonable financial decisions. This will help provide financial protection for that person.
Complete the resuscitation and care form to state the type of care you want when you can no longer make the decision for yourself.
Complete the emergency medical information form and add to your Yukon Care Consent Act forms and application package.