Out-of-province claim for physician/ practitioner services 2026

1. Click ‘Get Form’ to open the Out-of-province claim for physician/practitioner services in our editor.
2. Begin by filling in the patient’s surname, first name, and initials as they appear on the health card. Ensure accuracy to avoid processing delays.
3. Enter the health care number, permanent mailing address, and date of expiry. This information is crucial for verifying eligibility.
4. Provide the birthdate and sex of the patient. Indicate if this is a permanent move and include relevant dates of arrival and departure from the home province.
5. In section B, declare that the information provided is correct by signing and dating where indicated. If you are not the patient, specify your relationship.
6. For section C, have the physician/practitioner complete their details including name, specialty, and service duration. They should also indicate if surgical assistance was provided.
7. Finally, review all entries for accuracy before submitting your claim through our platform to ensure a smooth processing experience.

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