Overview

A personal claims history is a record of claims paid by OHIP. It lists payments made to health care professionals. These payments are for OHIP insured medical services received by an individual. This is personal health information.

The personal claims history lists the following information:

  • date of services
  • health care professional who performed the services
  • where the services took place

A personal claims history is not a medical record. Contact your health care professional for medical records about diagnosis and testing.

Access to personal claims history

You have a right to access your personal claims history. They are records of your personal health information. You must have an Ontario health card number to request your personal claims history.

For more information see section 53 of the Personal Health Information Protection Act, 2004 (PHIPA).

The ministry will process requests within 30 calendar days.

Individual requesting a personal claims history

You are an individual requesting a personal claims history if you are requesting:

  • for yourself
  • as a Substitute Decision Maker for someone else

The ministry will process requests within 30 calendar days. There is no cost associated with an individual request.

Submitting a request for individual personal claims history

To submit a request for individual personal health information:

  • access the form online form below
  • complete the form following the instructions on the first page
  • determine which claims history type you require ensure you have completed all mandatory fields
  • select the save button if you want to save a copy
  • select submit

Access to Personal Claims History Information by Individual or Individual's Substitute Decision Maker

You will receive a confirmation email. If you do not receive a confirmation email, contact: Claims Services Branch Inquiry Services at 1-800-262-6524.

Submission by mail

If you do not have access to the online form, contact: Claims Services Branch Inquiry Services at 1-800-262-6524 and request a paper copy.

To submit the paper form, please mail to:

Ministry of Health
Personal Health Information Office
49 Place d'Armes
Kingston ON K7L 5J3

Note: To process an individual request for personal claims history:

  • the individuals' health card mailing address must be current
  • must match the return address on the request form

If you need to update your address, contact ServiceOntario before submitting your application request.

Third parties requesting a personal claims history

You are a third party requesting a personal claims history if you are requesting:

  • for a law firm
  • an insurance company
  • information for a client

Third parties may ask a for personal claims history with the proper consent.

The ministry will process requests within 30 calendar days. There is a mandatory fee of $74 for a third-party request.

Consent form information

For a third party to ask for the release of health information, they must first get signed consent.

To provide this consent, the individual or substitute decision maker, must:

Consent Authorization Form: Disclosure of Personal Claims History Information to a Third-Party

To process the OHIP third party disclosure request form the:

  • health card mailing address must be current
  • health card number must match the address on the Consent Authorization Form

Submitting a request for third party personal claims history

To submit a request for third party personal claims history:

  • access the online form below
  • complete the form following the instruction on the first page

Request for Disclosure of Personal Claims History Information to a Third Party

Important: Before sending to the ministry attach the signed Consent Authorization form.

Selecting Submit will send you to the online payment webpage, CCPay. CCPay is an online payment service used by the Government of Ontario. It enables web-based payment requests for customers over the Internet. Offering real-time, secure, processing of online payment via credit cards (Visa or MasterCard).

Note to Mac/Apple/Mobile users: Currently online payment is unavailable.

Your application submission has not been successful if:

  • you are not re-directed to the online payment page
  • your payment submission does not go through
  • you do not receive a confirmation email

For help call Claims Services Branch Inquiry Services at 1-800-262-6524.

Submission by Mail

  • If you do not have access to the electronic form, contact 1-800-262-6524 to request a paper copy
  • Include a cheque made out to the Minister of Finance for the mandatory fee of $74 with the application form

To submit the paper form, please mail to:

Ministry of Health
Personal Health Information Office
49 Place d'Armes
Kingston ON K7L 5J3

Types of reports

There are two types of reports you can request, but only one type of report can be selected in Section 1 of the form.

  • Full Personal Claims History
  • Limited Personal Claims History

The Full Personal Claims History includes service dates, fee service code (FSC) and FSC description, fee paid, provider and clinic details.

The Limited Personal Claims History only includes service dates and provider number for services. This option will support request to Citizenship and Immigration Canada (CIC), or WSIB.

Disputing a claim

If an individual or their substitute decision maker disagrees with information in the personal claims history, contact the Ministry of Health at 1-800-262-6524.

Disputing a claim will not remove the claim from the ministry’s computer record. It will flag the claim as disputed.

Interpreting a personal claims history

Full Personal Claims History

The Full Personal Claims History contains the information shown below:

Personal Claims History for: Health Number, Name

Claim Period: Start Date to End Date

Service DateFSC+
FSC Description
Clinic Name
Clinic Municipality
Provider Name
Provider CPSO #
Provider Municipality
Referring Physician
Referring Physician CPSO #
Referring Physician Municipality
Spec Code
# / SERV
Fee Paid
Hospital #
YYYY-MM-DDA007A
Intermed, Asses/Well Baby Care-F.P.F.P/Paed
Gen Clinic
Hamilton
A.N. Other
000000
Toronto
J. Doe
000000
Ottawa
00
1
$33.70
0000

Definitions of headings on a Full Personal Claims History report

Health No:
The individual's 10-digit Ontario health card number.
Name:
The individual’s first and last name.
Service Date:
The date service(s) were received.
FSC (Fee Schedule Code):
A code used by the ministry to identify the service provided. For a more detailed description of each FSC, please consult the Schedule of Benefits.
FSC Description:
A brief description of the service provided.
Clinic Name:
If you received services from a clinic, this is the name of the visited clinic.
Clinic Municipality:
The municipality of the visited clinic.
Provider Name:
The first and last name of the health care professional who provided the service.
Provider CPSO #:
A unique identifier used by the College of Physician and Surgeons of Ontario. This identifies which health care professional provided the service. You can use this number to look up contact information for the provider.
Provider Municipality:
The municipality of the health care professional who provided the service.
Referring Physician:
The first and last name of the referring provider, if applicable.
Referring Physician CPSO #:
A unique identifier used by the College of Physician and Surgeons of Ontario. This identifies the referring provider if the service resulted from a referral. You can use this number to look up contact information for the provider.
Referring Physician Municipality:
The municipality of the referring provider, if applicable.
Spec Cd (Specialization Code):
The ministry uses this code to identify the type of specialist that provided the service(s).
# / Serv:
The number of units billed for this visit.
Fee Paid:
The fee paid to the health care professional for the service.
Hospital No:
If a hospital provided the service, the ministry uses this code to identify the hospital.

Limited Personal Claims History

The Limited Personal Claims History contains the information shown below:

Note: This report contains less personal health information than the complete report. It is often requested as documentation for:

  • Canadian Immigration (CIC)
  • Canadian Pension Plan
  • Workplace Safety and Insurance Board

Limited Personal Claim History for:

Health No, Your Name
Claim Period: Start Date TO End Date

Service DateProvider NameCPSO Number
2015-03-12John Doe123456

Definitions of headings on a Limited Personal Claims History report

Health No:
The individual's 10-digit Ontario health card number.
Name:
The individual’s first and last name.
Service Date:
The date service(s) were received.
Provider Name:
The first and last name of the health care professional who provided the service.
CPSO #:
A unique identifier used by the College of Physician and Surgeons of Ontario. This identifies which health care professional provided the service. You can use this number to look up contact information for the provider.