Request for Prior Approval for Full Payment of Insured Out-of-Country (OOC) Health Services

This form is meant to be submitted by a practicing Ontario physician on behalf of their patients to request consideration of funding for out-of-country health services. Along with the completed application form, submissions must also include relevant medical documentation.

Need help downloading or filling forms?

Please check our Help page for solutions to common issues.

Alert! Adobe is making changes that affect all PDF forms.

PDF Forms will no longer work with older versions of Adobe Reader including Adobe Reader XI. Please update your free Adobe Reader to the latest version from the Acrobat Reader download page so that you can continue to access these forms.


Download Adobe Reader Free Version

Make the most of your experience with accessing, downloading, and filling forms acquired from the Central Forms Repository by watching this brief video overview.

single frame of the linked video. Click to begin playback in a new browser window
Download English Transcript

Forms, Links, and Information

Additional Information

Form Number on00314
Title Request for Prior Approval for Full Payment of Insured Out-of-Country (OOC) Health Services
Description This form is meant to be submitted by a practicing Ontario physician on behalf of their patients to request consideration of funding for out-of-country health services. Along with the completed application form, submissions must also include relevant medical documentation.