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Ontario Medical Review
Nov. 10, 2020
Ontario Medical Association

This article originally appeared in the September/October 2020 issue of the Ontario Medical Review magazine.

The Forms Committee is Listening…

Who are we and what do we do?

The OMA Forms Committee advocates on behalf of physicians to reduce the amount of onerous and unnecessary paperwork. In consultation with OMA Sections, Assemblies, Committees, and individual members the Committee provides recommendations on specific forms to improve both the physician and patient experience. Forms reviewed by the Committee originate from both the federal and provincial governments, their agencies, insurance companies, third parties, and individual physicians.

The members of the OMA Forms Committee are:

  • Dr. Scott Elliott, Chair (Family Medicine)
  • Dr. Ken Arnold (Family Medicine)
  • Dr. Debbie Dyke (Family Medicine)
  • Dr. Jane Purvis (Rheumatology)

The mandate of the Committee includes:

  • advise on policies that will reduce the amount of administrative burden on physicians
  • review existing forms to determine those that can be modernized, modified, or eliminated
  • review new and revised forms intended to be completed by physicians
  • standardize forms to help make them easier to complete

Recent Committee Activity

The Committee has reviewed forms from the Ministry of Health, Transportation, Children Community and Social Services as well as from several individual agencies. We recently surveyed members on the requirements of specific forms used for requesting consultations. Given our mandate to reduce the numbers and simplify forms, the committee was alarmed by the increased number and complexity of unique forms being produced by some consultants.

Many physicians expressed concerns that the referral process did not conform to the CPSO’s policy. The referral note (irrespective of the form used) must include the information necessary for the consultant physician to understand the questions/issues being asked. Physicians must use their professional judgment to determine the information to be included in the referral request, the CPSO notes that this would typically include:

  • Patient, referring physician, and primary care provider identifying information (if different)
  • Reason(s) for the consultation and any information being sought or questions being asked
  • The referring physician’s sense of the urgency of the consultation
  • Summary of the patient’s relevant medical history, including medication information and the results of relevant tests and procedures.

If the nature of the patient’s condition requires an urgent consultation, CPSO suggests that a verbal request for referral may be appropriate, although it must be followed by a written request. Access further details on the relevant CPSO’s policy on referrals.

The Committee thanks those members who contributed to the survey and welcomes your feedback and comments on any of the information contained in this article. For more information please visit the Forms Committee web page.

Most Commonly Used Forms for Patient Care

A mandate of the Forms Committee is to review existing forms to determine those that can be modernized, eliminated or modified. For ease of reference, we have categorized the most commonly used forms for patient care into 5 categories: 

1. OHIP Insured Forms  

The April 1, 2020 OHIP Schedule of Benefits for Physician Services lists numerous forms that are insured under the provincial health plan. 

OHIP Fee Code Form Description 2020 Fee Value
A/C/W771 Medical Certificate of Death – Form 16(007-11291) $20.60
K026 Application for Ontario Hepatitis C Assistance Plan (OHCAP) – Physician Form (014-3589-22) $54.70
K027 Application for Ontario Hepatitis C Assistance Plan – (OHCAP) – Physician Form (014-3700-22) – includes only completion of application for OHCAP – physician’s form without an associated consultation or visit on the same day $21.85
K031 Form 1 – Physician Report – Pursuant to the Mandatory Blood Testing Act, 2006 and O.Reg.449/07 (008-11-001) $102.50
K035 Medical Condition Report (023-5108) $36.25
K036 Application for Northern Health Travel Grant (014-0327-88) $10.25
K038 Health Assessment – Local Health Integration Network (LHIN) (014-4768-69E-LHIN) 5 $45.15
K070 Home Care Application form to a CCAC $31.75
K623 Form 1 – Application by Physician for Psychiatric Assessment (014-6427-41) $113.35
K624 Form 3 – Certification of Involuntary Admission (014-6429-41) $139.60
K629 Form 3 – Certificate of Involuntary Admission (014-6429-41) All other re-certification(s) of involuntary admission including completion of appropriate forms $41.35
E077 Request for a Major Eye Examination (014-4347-84) (add) $10.25
K887 Form 45 – Community Treatment Order (014-3760-41), CTO initiation including completion of the CTO form and all preceding CTO services directly related to CTO initiation (per unit) $84.70
K889 Form 45 – Community Treatment Order (014-3760-41), CTO renewal including completion of the CTO form and all preceding CTO services directly related to CTO renewal (per unit) $84.70

2. Uninsured forms billable to OHIP  

The OHIP Schedule of Benefits lists forms in Appendix F that are uninsured but billable to OHIP. The services in Appendix F are not “insured services” within the meaning of the Health Insurance Act, but are paid by the MOH, acting as a paying agent. Physicians can submit claims through OHIP using the following fee codes summarized in this table: 

OHIP Fee Code Form Description 2020 Fee Value
K050 Health Status Report and Activities of Daily Living Index (006-2859), (completion of amalgamated forms for initial ODSP application) $103.55
K051 Health Status Report (006-2859) completed separately for initial ODSP application $82.85
K052 Activities of Daily Living Index (006-2859), completed separately for initial ODSP application $20.70
K053 A Limitation to Participation Form, (006-2844) $15.55
K054 Mandatory Special Necessities Benefit Request Form (006-2957) $25.90
K055 Application for Special Diet Allowance (006-3111) $20.70
K056 Application for Pregnancy/Breast- Feeding Nutritional Allowance $20.70
K057 ODSP Medical Form Part A for Medical Review Process (006-3204) $35.00
K058 ODSP Medical Form Part B Health Status Report and Activities of Daily Living Index for Medical Review process (006-3205) $129.40
K059 ODSP Medical Form Part B Health Status Report (006-3205) (completed separately) $103.55
K060 ODSP Medical Form Part B, Activities of Daily Living Index (006-3205) (completed separately) $25.90

3. Unremunerated forms  

There are various forms that we are required by legislation to complete, which may not be charged to the patient, and may not be submitted to OHIP for payment. Section 24 of the Health Insurance Act R.R.O. 1990, Regulation 552 Amended to O. Reg. 352/04 stipulates what is considered an “uninsured” service and what cannot be submitted to OHIP for payment. Examples:  

  • Application for Accessible Parking Permit (002-SR-LV-129E) 
  • Eligibility transit application forms  
  • Children’s Aid Society forms (on behalf of a child) 
  • Ministry of Health forms (e.g. Request for an Unlisted Drug Product (4406-87), ADP Assistive Device forms)   

4. Uninsured and Third-party forms – billable to patients or a third-party

The OMA Uninsured Services Committee maintains a guide for physicians with advice on billing for uninsured and third-party services. The following table extracted from 2020 Physicians Guide to Uninsured Services highlights some examples of uninsured forms: 

Uninsured Report Forms Suggested Fee for Form Completion Only
Completion of forms associated with patient physicals:
Schools/camps $28.50
Admission to daycare, preschool, university (includes out of province and international universities) $28.50
Pre-employment certification of fitness/fitness clubs $38.25
Hospital/nursing home employees $38.25
Completion of licensing forms/certificates:
Drivers medical examination form $59.00
Civil aviation medical examination report 26-0010E (001004) Physician’s hourly rate
Completion of work and school related forms/notes:
Sick notes (includes return to work/school notes) $20.00
Fitness to work note[1] Independent consideration
Certificate of freedom from communicable disease $20.00
Other forms/certificates:
Revenue Canada, Federal Disability Tax Credit $75.00
Children’s Aid Society (CAS) application for prospective foster parent $59.00
Medical Certificate Employment Insurance Sickness Benefits INS5140 $40.00
Miscellaneous insurance forms:
Travel cancellation insurance form $39.00
Life insurance death certificate $48.75
Medical certificate for employment insurance compassionate care benefits $56.00

Note: [1] The fee for a sick note ($20.00) is intended to be a brief note that confirms diagnosis and/or duration of time off/needed. Fitness to work represents a more comprehensive service that might require a detailed explanation about a patient’s current capabilities and ongoing management, in the context of being fit for employment. 

5. WSIB forms

The Workplace Safety and Insurance Board (WSIB) provides an up-to-date listing of forms and fees in its Physician Fee Schedule. An increase of 1.9% was applied to the existing fee-for-service rates for ten of Ontario’s regulated health professions to existing fee schedules. Visit for details on physician fees.