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ADP Form 4793-67E: Respiratory Equipment Funding

Ontario's Assistive Devices Program uses this application to fund positive airway pressure systems, medication and high output compressors, suction units, infant apnea monitors, airway clearance devices and tracheostomy equipment. The prescriber ticks each device section that applies and confirms its eligibility criteria. The ADP-registered vendor then submits the signed form, and ADP shares the equipment cost with the patient.

Who completes it

A physician or nurse practitioner completes Section 2 (Devices and Eligibility) and signs Section 4, but Section 2a for CPAP, APAP or BPAP is marked for physicians and needs the ADP clinic number of the sleep clinic that made the diagnosis. The applicant or agent completes Sections 1 and 3, and the vendor completes the vendor, equipment and proof-of-delivery parts.

Submitting and payment

How to submit it
The form may go to ADP only after the applicant or agent, the physician or NP, and the vendor have all signed; the ADP-registered vendor submits it. Repair quotes or bills for worn-out equipment are the only attachments ADP considers.
Who pays
No prescriber fee appears on the form; ADP pays the vendor 75% of the approved equipment price (up to 100% for OW, ODSP or ACSD recipients) and pays suction and tracheostomy supply grants to the patient in quarterly instalments.

Good to know

  • PAP eligibility needs a Level 1 sleep study confirming obstructive sleep apnea, with symptoms present without therapy and absent with it, and the sleep lab must give the patient ADP's respiratory fact sheet.
  • BPAP requires documented OSAS plus persistent hypoxemia, hypercapnia or AHI over 10 despite CPAP of 15 cmH2O or more, intolerance of that pressure, or intolerance of any CPAP.
  • ADP pays only for equipment bought on or after the date the physician or nurse practitioner signs the form; anything ordered earlier is the patient's full cost.
  • Apnea monitors are rented for at most six months for infants who are SIDS siblings, had an ALTE, or have apnea past 37 weeks corrected age; purchase is for tracheostomy only.

Get the official form

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

Application for Funding - Respiratory Equipment & Supplies

Demande de financement Équipement et fournitures respiratoires

Official pagePDFVersion française

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How this list is checked

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

Can a nurse practitioner sign ADP's respiratory equipment form?

Yes for compressors, suction, apnea monitors, airway clearance devices and tracheostomy equipment: Section 2 and the Section 4 signature accept a physician or nurse practitioner. CPAP, APAP and BPAP differ, because Section 2a is marked for physicians and ADP requires assessment by a physician working at an ADP-registered sleep clinic.

Does ADP cover CPAP masks and other supplies?

ADP's program page lists replacement CPAP masks and headgear as not covered, along with oral appliances for sleep apnea, high-frequency chest wall oscillation devices, standalone humidifiers, peak flow meters, adaptive servo-ventilators and spacers. Suction and tracheostomy supplies are funded through an annual grant that must be renewed every 2 years.

How long does ADP take to review a respiratory application?

ADP's applicant information sheet estimates about six weeks from receipt of a properly completed form, and the program page sets an 8-week review target. If ADP cannot approve funding, the physician or nurse practitioner is notified by mail; if it approves, ADP notifies the vendor, who arranges delivery.