Fill your part of the ADP breast prosthesis application, fast

The Assistive Devices Program provides a grant toward an external breast prosthesis for eligible Ontarians, and the application is split into sections — one for you, one for your authorizer, and one for your vendor. This guide is an example of using hivi to fill your applicant section quickly.

Official form and source

Start from the official source and always use the current version — form numbers and links can change:

• Service page: Assistive Devices Program — ontario.ca
• Form (Central Forms Repository): Application for Funding Breast Prosthesis Grant — 014-4392-67

What this form is about

The ADP breast prosthesis grant helps cover the cost of an external prosthesis for those who have undergone a mastectomy or similar surgery. The Ministry of Health funds a portion of the cost, and the application documents your identity alongside clinical and vendor details.

Before you start: what to gather (your section)

• Your full legal name and current Ontario address.
• Your Ontario health number.

Your authorizer (a regulated health professional registered with the ADP) will assess your eligibility and complete their section, and your vendor will provide the device details. Confirm documentation requirements on ontario.ca.

How hivi makes it faster

1. Store your details once. Save your name, address, and health number in hivi — the same details you use on every Ontario health and benefits form.
2. Autofill your section. Use the hivi Chrome extension on a web form, or fill a PDF from your saved profile inside hivi.
3. Your authorizer and vendor complete their sections. hivi does not touch those parts.
4. Review, then submit to the Ministry of Health.

Why do it in hivi

Your name, address, and health number appear on ADP funding forms, OHIP forms, dental program applications, and dozens of other Ontario health forms. Store them once in hivi — in Canada, with self-hosted AI — and every applicant section starts mostly complete.