Charges for Uninsured Services (NOT COVERED BY OHIP)
Ontario Medical Association (OMA) Guidelines
TYPE OF SERVICE
Completion of Form Physicals for:
Schools/Camps
DESCRIPTION OF UNINSURED FORM/REPORT/SERVICE
FEE
$26.00
Admission to Day-Care, Preschool, University or any other educ-al institution
$26.00
Pre-employment Certification of Fitness/Fitness Clubs
$34.00
Hospital/Nursing Home Employees
$34.00
Drivers Medical Examination
Completion of Licensing
Forms/Certificates:
Civil Aviation Medical Examination Report
Pilots License Validation
Administrative License Suspension Appellant Medical Info. Form
Back to Work Notes/Sick Notes
Completion of Work and School
Federal Employee Absence Notes
Related Forms/Notes:
$52.00
Physician hrly
rate
Physician hrly
rate
$40.00
$18.00
$26.00
Day Care Note (free of communicable disease)
$18.00
OCF-18 Treatment Plan
$130.00
OCF-3 Disability Certificate
$130.00
OCF-19 Determination of Catastrophic Impairment
$107.00
Insurance Certificates: (Note: An OCF-22 Approval of an Assessment
assessment fee can be charged in Travel Cancellation Insurance Form
$122.00
addition to the insurance form fee
if an assessment is necessary to
obtain relevant information
needed to complete the form)
$44.00
Life Insurance Death Certificate
Medical Certificate for Employment Insurance Compassionate Care Benefits
$50.00
Attending Physician’s Statement
$130.00
System – Specific or Disease Specific Questionnaire
$87.00
Insurance Medical Examination
$212.00
System-Specific Examination
$104.00
Full Narative/Clarification Report
Citizen and Immigration Canada Medical Report for Immigration
Government Forms:
Other Certificates:
$349.00/hr
$130.00
CPP Disability Medical Report Form
$85.00
CPP The Narative Medical Report
$150.00
Request for Medical Information re: Applicants to Canadian Armed Forces
$102.00
Central Collection Service Request for Physician’s Information
$130.00
Revenue Canada, Federal Disability Tax Credit
$44.00
Auto Sales Rebate Form
$35.00
Children’s Aid Society Application for Prospective Foster Parent
$52.00
Medical Certificate Employment Insurance Sickness Benefits
TB Test requested by Ministry of Health Program (eg. Public Health)
TB Mantoux Testing***
$35.00
TB Test requested for admission or continuation in a day care, pre-school, school, college, university or
other educational institution. TB Test Insured by OHIP. Charge for Form/Report Completion
TB Test requested for employment purposes (Test + Form)
$26.00
OHIP covered
$20.00
$45.00
Application for Accessible Parking Permit/Transit Forms for Disabled
Unremunerated Report Forms:
(Physician is NOT permitted to PR Card Forms/Request for Birth Certificate Form/Canadian Passport Application
charge a patient for completion) Children’s Aid Society Form (on behalf of a child)/Ministry of Health and Long-Term Care (eg. Limited Use,
Assistive Devices etc.)
Copies from the Patient’s Chart (up to 20 pages)
Chart Copies:
Copy of the Full Chart (over 20 pages). $30.00 + $.25 per page for each page over 20 pages.
Letter for massage therapy, orthotics, back support, stockings etc.
Missed Appointment
Other:
PAP Test***
No Charge
$1.00/pg.
$30.00 +
$0.25/pg.
$30.00
$40.00
Lost requisition/Referral
$5.00
Fax Prescription refill
$15.00
Travel Advice and Vaccine Administration (must be purchased from Pharmacy)
$65.00
Charge for PAP Test by Physician
$36.00
Processing Fee - payable directly to Processing Laboratory (e.g. CML)
$20.00
*** MAYBE COVERED BY OHIP IF CERTAIN CRITERIA ARE MET