Non-Ohip Billing Fees
(fees subject to change without notice)
|
Auto Accident Benefits |
$135.00 |
| Camp/Shool/Daycare Form |
$30.00 |
|
Chart Transfer |
$30.00 |
|
CPP Disability Medical Report Form |
$85.00 |
|
Disability Tax Credit Form |
$75.00 |
|
Doctor Note (back to work/sick/day care) |
$20.00 |
|
Employment Certificate of Fitness |
$50.00 |
|
Forms for compassionate care benefits, trip cancellation |
$50.00 |
|
Forms for insurance coverage (massage, etc) |
$20.00 |
|
Immunization (out-of-province) |
N/A |
|
Insurance Attending Physician Statement |
$125.00 |
|
Letters (per 1/2 hour) |
$50.00 |
|
Life Insurance Death Certificate |
$60.00 |
|
Liquid Nitrogen |
$25.00 |
|
Maternity Leave, employment, sickness benefit forms |
$20.00 |
| Missed Appointment |
$40.00 |
| Missed Physical Appointments |
$75.00 |
| MTO Exam with Form |
$125.00 |
| OSAP Disability Verification |
50.00 |
| Pre Placement Health Form Immunizations |
$30.00 |
| Prescription Renewals |
N/A |
| TB Test |
$40.00 |
Payments for the above services are to be made payable to: Petawawa Centennial Family Health Centre