Ontario's Ministry of Children, Community and Social Services uses form 3183E when a vision care provider needs pre-authorization for medically necessary items that are not in the vision care fee schedule, such as medically necessary contact lenses. The provider records the prescription, lens type and itemized costs, then explains why basic eyeglasses cannot meet the client's needs. A ministry director records the maximum amount approved.
The vision care service provider, such as an optometrist or optician registered as a supplier, completes Sections C to E with their licence and supplier numbers, the prescription and the justification. The recipient, or someone lawfully authorized, signs the Section B declaration and consent.
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Vision Care Benefit (Exceptional Circumstances)
Demande de prestations pour soins de la vue (circonstances exceptionnelles)
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Section E asks the provider to outline the client's special needs and explain why they cannot be met with basic eyewear as set out in the ministry's vision care schedule. Medically necessary contact lenses are the main example, with corneal abnormalities, uncorrectable astigmatism, high refractive error and anisometropia listed on the form.
Yes. The ministry's form description says service providers must obtain pre-authorization before providing these services to clients. A ministry director signs Section F and records the maximum amount approved, so the decision comes before the requested items are supplied.
No. It is an XFA-based e-form that opens and fills correctly only in Adobe Acrobat or Reader, and the Central Forms Repository warns that older versions such as Adobe Reader XI no longer work. A French version, 3183F, is posted alongside the English form.