Out of Province Claim for Physician Services
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.
Forms, Links, and Information
-
English - 014-0000-80e - Out of Province Claim for Physician ServicesPDF
-
French - 014-0000-80f - Out of Province Claim for Physician ServicesPDF
-
English - 014-0000-80e - Out of Province Claim for Physician ServicesHTML
-
French - 014-0000-80f - Out of Province Claim for Physician ServicesHTML
Additional Information
Form Number | 014-0000-80 |
---|---|
Title | Out of Province Claim for Physician Services |
Description | Under Interprovincial agreement, for travel within Canada, patients/physicians submit form to get reimbursed by applicable health plan. |