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ODSP Mandatory Special Necessities Form (ON00646E)

Ontario Disability Support Program recipients use this application to get help with medical travel and with diabetic supplies, surgical supplies and dressings, and items and devices needed because of a surgical, radiological or medical procedure or disease. A health professional completes only the sections that match the patient's documented needs, including a 12-month medical transportation plan. Approval is based on the most economical cost.

Who completes it

Physicians, nurse practitioners, registered nurses, occupational therapists, physiotherapists and physician assistants licensed in Ontario can complete the clinical sections, and psychologists may complete only the Medical Transportation section. The applicant, or someone lawfully authorized, signs the declaration and consent on page 1.

Submitting and payment

How to submit it
The completed form can be submitted online through MyBenefits, given to the local ODSP office, or mailed to the address on page 1, with vendor estimates or quotes if available.
Who pays
Physicians bill OHIP fee code K054, while nurse practitioners, registered nurses, physician assistants, occupational therapists, physiotherapists and psychologists send the ministry an invoice as described on page 4.

Good to know

  • Only ODSP recipients are eligible, and only items in the MSN Schedule of Benefits that cannot be reimbursed from another source are covered.
  • Public transit or para-transit is the default; the form asks whether a medical condition prevents its use and whether specialized patient transportation is needed.
  • Most supply categories, such as wound care, lymphedema, incontinence, braces, respiratory and monitoring devices, ask for the expected duration: 3, 6 or 12 months, or indefinite.
  • For diabetic supplies in gestational diabetes, give the expected date of delivery. The ministry may ask for supporting information, including verification of attendance at appointments.

Get the official form

Download the current version from the source each time; forms change without notice.

Ontario Disability Support Program (ODSP) - Mandatory Special Necessities (MSN) Benefit Application

Programme ontarien de soutien aux personnes handicapées (POSPH) Demande de Prestations obligatoires pour les nécessités spéciales

Official pagePDFVersion française

Fill it with Vero

Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.

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Frequently asked questions

Who can fill out the ODSP Mandatory Special Necessities form?

Physicians, nurse practitioners, registered nurses, occupational therapists, physiotherapists and physician assistants licensed in Ontario can complete the medical transportation and supplies sections. Psychologists can complete only the Medical Transportation section. The professional signs page 4 and adds their profession, regulatory college and registration number.

What medical travel does the MSN benefit cover?

Travel to medical treatment provided by a health care professional, to local alcohol and drug recovery groups, and to mental health therapy prescribed by a physician or psychologist. The table lists each visit location and provider, visits over the next 12 months, the dates required, and whether an attendant or overnight stay is needed.

Is the MSN form available in French or large print?

Yes. The Central Forms Repository posts fillable, large print and print-ready versions in English (ON00646E) and French (ON00646F). The current English edition is ON00646E (2025/11), and the fillable version needs an up-to-date version of Adobe Reader.