OHIP block fee
2013 GUIDE TO FEES FOR UNINSURED SERVICES (Visit UninsuredServices.ca)
Charge for Note completion may consist of up to three (3) separate components and their summation is the total cost
EXAMINATION
FEE
HOURLY FEE
For CHART REVIEW
+
+
FORM
FEE
TOTAL
FEE
=
HOURLY CHARGE - hourly charge calculated as per the OMA 2013 Guide to Third Party & Other Uninsured Services (www.oma.org). 15 min minimum charge may apply.
Administrative License Suspension Appellant Medical
Information Form
Admission to Daycare Physical Forms
$45.00
$30.00
Appearance Before Advisory Review Board or Review Board
Approval of an Assessment or Examination (#OCF – 22)
Attending Physician Statement
Auto Sales Tax Rebate Form
Back to Work Notes/Sick Notes
Camps Physical Forms
CAS Application for Prospective Foster Parents
$30.00
$55.00
Central Collection Service Request for Physician’s Information
Certificate of Health Practitioner (#OCF-8)
Certification of Incompetence (Financial)
Certification Procedures Regarding Management of Estate
Chart Demand Surcharge less $146.90/ ½ hr
$125.00
$129.45
$40.00
$25.00
1 day or
< 2 days
< 4 days
< 7 days
Citizenship & Immigration Canada Medical Report for
Immigration
Civil Aviation Medical Examination Report 26-0010E (001004)
Clarification Report – Life & Health Insurance
Completion of Forms and Procedures Dictated to the Mental
Health Act
Court Appearance
CPP Disability Medical Report Form
Day Care Sick Note (free of communicable disease)
Determination of Catastrophic Impairment (#OCF-19/59)
Diagnostic Interview and/or Counselling with Child and/or
Parent for Testing
Disability Certificate (#OCF-3)
Disability Medical Report CPP Form
$125.00
$45.00
$269.75
Independent
Consideration
$130.00
$105.00
$80.00
$55.00
$125.00
$85.00
$348.90/hr
Independent
Consideration
Per hourly rate
$125.00
$25.00
$105.00
$130.00/ ½ hr
Missed Appointments Without 24hr
Charge for Note completion may consist of up to three (3) separate components and their summation is the total cost
EXAMINATION
FEE
HOURLY FEE
For CHART REVIEW
+
+
FORM
FEE
TOTAL
FEE
=
HOURLY CHARGE - hourly charge calculated as per the OMA 2013 Guide to Third Party & Other Uninsured Services (www.oma.org). 15 min minimum charge may apply.
Administrative License Suspension Appellant Medical
Information Form
Admission to Daycare Physical Forms
$45.00
$30.00
Appearance Before Advisory Review Board or Review Board
Approval of an Assessment or Examination (#OCF – 22)
Attending Physician Statement
Auto Sales Tax Rebate Form
Back to Work Notes/Sick Notes
Camps Physical Forms
CAS Application for Prospective Foster Parents
$30.00
$55.00
Central Collection Service Request for Physician’s Information
Certificate of Health Practitioner (#OCF-8)
Certification of Incompetence (Financial)
Certification Procedures Regarding Management of Estate
Chart Demand Surcharge less $146.90/ ½ hr
$125.00
$129.45
$40.00
$25.00
1 day or
< 2 days
< 4 days
< 7 days
Citizenship & Immigration Canada Medical Report for
Immigration
Civil Aviation Medical Examination Report 26-0010E (001004)
Clarification Report – Life & Health Insurance
Completion of Forms and Procedures Dictated to the Mental
Health Act
Court Appearance
CPP Disability Medical Report Form
Day Care Sick Note (free of communicable disease)
Determination of Catastrophic Impairment (#OCF-19/59)
Diagnostic Interview and/or Counselling with Child and/or
Parent for Testing
Disability Certificate (#OCF-3)
Disability Medical Report CPP Form
$125.00
$45.00
$269.75
Independent
Consideration
$130.00
$105.00
$80.00
$55.00
$125.00
$85.00
$348.90/hr
Independent
Consideration
Per hourly rate
$125.00
$25.00
$105.00
$130.00/ ½ hr
Missed Appointments Without 24hr