Forms

Ontario Health Insurance (OHIP)

Forms are listed alphabetically in Portable Document Format (PDF). To view and print the forms, you need to have Adobe Acrobat? Reader installed on your computer. You can download this free software from the Adobe Web site.

Click on the form title to open the form. You can fill-in the form on your screen and print it, or use the disk icon on the Reader toolbar to save a blank copy of the form to your computer. Filled-in forms cannot be saved.

Link to Public OHIP Forms and Applications

5041-77 Request for Prior Approval for Funding of Sex-Reassignment Surgery
4963-84 Request for Prior Approval for Full Payment of Insured Out-of-Province (OOP) Health Services
4860-84 Vendor Application for Conformance Testing - Acceptable Use Policy
0022-84 OHIP Group Registration for Health Care Professionals
4885-84 Change of Address for Health Care Professionals
4520-84 Prior Approval Application for Full Payment of Insured Out-of-Country (OOC) Health Services
4521-84 Prior Approval Application OOC - Request for Diagnostic Laboratory Testing
4524-84 Prior Approval Application OOC - Emergency/911/CritiCall Transfers
4422-84 Laboratory Requisition
4421-84 Reciprocal Claim
4420-84 Health Claim
4347-84 Request for Major Eye Examination
7698-84 Application for OHIP Direct Bank Payment for Health Care Professionals
3134-84 Application for IVR Participation
3256-82 Application for Reimbursement under the Medical Liability Protection (MLP) Program
0864-84 Authorization for Group Payment
2404-84 Claims Flagged for Manual Review
3759-83 Community Treatment Order (CTO) Report Log
7178-84 Declaration of Hospital Insurance Coverage
1265-84 Health Number Release
7158-84 In-Patient Standard Ward Costs
3889-84 Medical Liability Protection (MLP) Reimbursement Program Authorization
0000-80 Out of Province Claim for Physician Services
7521-84 Out of Province Out-patient Services
3384-83 Application for OHIP Billing Number for Health Professionals
0918-84 Remittance Advice Inquiry
2743-84 Request for Approval of Payment for Proposed Dental Procedures
0691-84 Request for Approval of Payment for Proposed Surgery
7179-84 Summary of Inpatient Expenses

For More Information

Call ServiceOntario, Infoline at:
1-866-532-3161 (Toll-free)
In Toronto, (416) 314-5518
TTY 1-800-387-5559.
In Toronto, TTY 416-327-4282
Hours of operation : 8:30am - 5:00pm