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 (in another province/territory)

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

Request for Prior Approval for Full Payment of Insured Out-of-Country Health Services

4521-84

Application for Prior Approval for Full Payment of Insured Out-of-Country (OOC) & Out-of-Province (OOP) Laboratory & Genetics Testing

4524-84

Application for Approval of Full Payment of Insured OOC Health Services - Emergency/911/CritiCall Transfers

4422-84

Laboratory Requisition - Requisitioning Physician / Practitioner

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

0864-84

Authorization for Group Payment

2404-84

Claims Flagged for Manual Review

3759-83

Community Treatment Order (CTO) Report Log

1265-84

Health Number Release

7158-84

In-Patient Standard Ward Costs

3889-84

Medical Liability Protection (MLP) Reimbursement Program Authorization/Direct Deposit Request

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: Monday to Friday, 8:30am – 5:00pm

 
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