Executive Director/CEO or signing authority name and email address
Executive Assistant Equivalent (Office Manager) name and email address
Note
title
Please skip the following field on the Client Information Form (CIF):
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This form is also a self-attestation that your organization is a Health Information Custodian (HIC) under PHIPA. You must be a HIC to enter into agreement with Ontario Health.
Please include your letters patent, incorporation documents, or name change documents along with this form to confirm your legal name.
UI Step
You must select a CMS vendor through your organization’s procurement process. The following CMS applications are eligible for the one-time funding opportunity:
CRMS
VitalHub Treat
Vitalhub CaseWORKS
EMHWare
UI Step
Once you choose a vendor, you must submit an itemized quote for the full and final cost of the migration.
Warning
This quote will be used to draft the agreement between your organization and Ontario Health (OH) and OH cannot adjust funding amounts if the final invoice exceeds the quoted amount. If the final amount paid is less than the quoted amount included in the agreement, OH will recover the difference.
Examples of vendor costs to be reimbursed by One-Time Funding Opportunity
One year licensing, subscription or maintenance fee
Data Migration / Data Transfer (can include cost/invoice from current vendor system & cost of migration to new system) *please note that you will be required to submit an invoice from your current vendor and new vendor if applicable
User Licenses / Software Licenses
Training
Office 365 Integration
MHA Applicable Modules
Configuration
Vendor supports.
Examples of vendor costs that are not eligible for one-time funding
Ongoing licensing/subscription fees
Purchasing of new software or equipment unrelated to the CMS migration (e.g. Microsoft 365, computers)
Custom reporting outside the scope of MHA.
UI Step
The completed Client Information Form and Quotes must be submitted via your existing Expression of Interest ticket on the Mental Health and Addictions Provincial Data Set (PDS) Service Desk (for step-by-step instructions on how to attach files to a ticket, go to the bottom of this page). Quotes will be accepted between November 11th, 2024 and January 6th, 2025. Funds will be allocated on a first come, first serve basis until the pool of funds is exhausted.
UI Step
OH will confirm the final funding amount to be allocated to the HSP within 3-5 business days of receipt of the quote submission.
If you have any questions, please submit them via your existing Expression of Interest ticket.
8.5.7, themed by Refined