Ohip reimbursement claim form 2025

1. Click ‘Get Form’ to open the OHIP reimbursement claim form in the editor.
2. Begin by filling out the 'Patient Information' section. Enter your Health Number, last name, first name, date of birth, and contact details including home and business telephone numbers.
3. Provide your residence and mailing addresses. Make sure to include the province and postal code for both addresses.
4. Indicate your travel details by entering the dates of departure from and return to Ontario. Specify if you have any supplementary insurance coverage.
5. In the 'Treatment Information' section, confirm whether the treatment was required due to an acute condition outside Ontario. Fill in the reason for visit, type of treatment received, place of treatment, and treatment date.
6. Complete the 'Hospital Information' section by providing admission and discharge dates along with the hospital's name and address. Indicate whether you were an inpatient or outpatient.
7. Finally, sign and date the authorization section to direct payment to your hospital or health facility.

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