Request for Prior Approval for Insured OOC Health Services
This form is essential for obtaining prior approval for insured out-of-country health services. It details physician responsibilities and the required patient information. Proper completion ensures coverage for necessary medical treatments outside of Ontario.
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How do I fill this out?
Start by gathering all necessary information regarding the patient and the proposed out-of-country treatment. Confirm that the patient's health number and address are accurate. Ensure all sections of the form are clearly legible before submission.
How to fill out the Request for Prior Approval for Insured OOC Health Services?
1
Gather the patient's health information and details about the treatment.
2
Complete all sections of the form thoroughly.
3
Ensure the form is legible and free from any errors.
4
Obtain signatures from the patient and the referring physician.
5
Submit the completed form via fax or mail as directed.
Who needs the Request for Prior Approval for Insured OOC Health Services?
1
Ontario physicians who need to refer patients for OOC treatment.
2
Patients requiring treatments that are not available or have long wait times in Ontario.
3
Individuals seeking specialized medical services offered only outside the country.
4
Patients needing urgent medical attention that cannot be delayed.
5
Health care professionals coordinating complex cases requiring interdisciplinary consultations.
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Download or share the edited PDF as needed.
What are the instructions for submitting this form?
Submit this form by fax at 613 536-3181 or 1 866 221-3536. Alternatively, you can mail it to the Health Services Branch, Provider Facility Payment Unit, Out of Country Program, 1055 Princess Street, PO Box 168, Kingston ON K7L 5V1. Ensure the form is complete and all required fields are filled out to avoid delays.
What are the important dates for this form in 2024 and 2025?
Please check the relevant ministry resources for any important submission deadlines or changes in the regulations for the years 2024 and 2025.
What is the purpose of this form?
The purpose of this form is to facilitate the approval process for insured out-of-country health services. It allows Ontario physicians to request necessary medical treatments not available within the province. By properly completing this application, patients can ensure their required medical needs are met through appropriate channels.
Tell me about this form and its components and fields line-by-line.
- 1. Patient Information: Collects demographic and health information of the patient.
- 2. Referring Ontario Physician: Information on the doctor making the referral.
- 3. Proposed OOC Health Facility/Hospital: Details about the out-of-country facility where treatment is sought.
- 4. Treatment - General Information: Describes the proposed treatment or procedure.
- 5. Treatment Availability: Validates the necessity for OOC treatment.
- 6. Follow-up Care: Confirms arrangements for follow-up care in Ontario.
What happens if I fail to submit this form?
Failing to submit this form can result in denial of approval for necessary medical treatments. Patients may need to seek alternative methods of securing care without coverage. It is crucial to ensure all sections are completed to prevent delays.
- Incomplete Information: Missing details may lead to form rejection.
- Late Submission: Submitting past deadlines can cause delays in treatment.
- Incorrect Treatments Listed: Listing ineligible treatments will invalidate the request.
How do I know when to use this form?
- 1. Specialized Treatments: For access to specialized procedures offered outside Ontario.
- 2. Urgent Care Needs: When immediate treatment is required to avoid deterioration.
- 3. Long Wait Times: When local service availability is severely restricted.
Frequently Asked Question
What is the purpose of this form?
This form is used to request prior approval for out-of-country health services.
Who can fill out this form?
Only an attending Ontario physician can complete this form.
How do I submit the form?
You can submit the form by fax or mail to the specified addresses.
What happens if my application is incomplete?
Incomplete applications will be returned for clarification.
What kind of treatments require this form?
This form is required for medically necessary treatments not available in Ontario.
Is there a deadline for submission?
It is best to submit the form as soon as treatment is deemed necessary.
Can I edit the form after filling it out?
Yes, you can edit the form using PrintFriendly's PDF editor.
How do I get help if I have questions?
You can contact the ministry's toll-free number for assistance.
What should I do if my patient is under 16?
A parent or legal guardian must sign the form on behalf of the patient.
Can I save the edited PDF on PrintFriendly?
Users can download the edited PDF directly after completing their changes.
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