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Saskatchewan Nutritional Products Program Application

A dietitian completes this two-page Ministry of Health application to request help with the cost of a therapeutic nutritional product for a Saskatchewan patient, as an initial application or a re-assessment. The dietitian documents the medical condition, the formula, monthly volume, duration and estimated monthly cost. The family adds an income declaration, and the ministry uses family income and drug costs to calculate assistance.

Who completes it

The dietitian completes Patient Identification, Clinical Information and Referral Information, including the share of nutritional requirements met by the product, and signs. The patient or parent/guardian, a spouse and any trustee or attorney sign the Declaration and Consent and complete the Income Declaration.

Submitting and payment

How to submit it
Mail the completed application to the Ministry of Health's Drug Plan and Extended Benefits Branch at the address printed on the form, with the most recent Notice of Assessment attached.

Good to know

  • The dietitian records whether the family already receives help with nutritional product costs through another program, such as social assistance or palliative care.
  • Attach the latest Notice of Assessment showing qualifying family income: the client and spouse, or both parents when the patient is a child.
  • The consent lets ministry officials see the family's Drug Plan prescription costs and verify income information held by the federal revenue agency, employers and other government agencies.
  • Families can add written explanations, such as income changes or new medications or products, and attach Schedule 3 when reporting capital gains.

Get the official form

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

Therapeutic Nutritional Products Program Application

Official pagePDF

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Frequently asked questions

Who completes the Saskatchewan nutritional products application?

A dietitian completes the patient identification, clinical information and referral sections and signs the form. The patient or parent/guardian completes the declaration, consent and income declaration, and a spouse and any trustee, guardian or power of attorney also sign where applicable.

What clinical information does the dietitian provide?

A description of the medical condition showing the need for the product, the percentage of nutritional requirements met through it, the formula prescribed, anticipated volume per month, anticipated duration of therapy, estimated cost per month and the anticipated product vendor.