Process chronic care co-payments without retyping patient and hospital details

Hospital chronic care co-payment forms repeat the patient's name, health number, attending physician details, and hospital contact information when meals and accommodation charges apply. This guide is an example of storing them once in hivi.

Official form and source

Start from the official source and always use the current version — form numbers and links can change:

• Service page: Hospital chronic care co-payment — ontario.ca
• Form (Central Forms Repository): Hospital Chronic Care Co-payment Form — 014-3264-54

What this form is about

Form 014-3264-54 is the Hospital Chronic Care Co-payment Form used when a designated hospital charges a co-payment for chronic care patients who are more or less permanently resident.

Before you start: what to gather

• Patient full legal name and health number.
• Hospital name, address, and billing contact.
• Attending physician name and determination date.
• Co-payment start date — confirm rules on ontario.ca.

Confirm the current process on ontario.ca.

How hivi makes it faster

1. Save it once. Store your patient name and hospital contact details in your hivi profile.
2. Keep documents ready. Upload supporting documents to hivi Files so you are not searching at form time.
3. Autofill the form. Use the hivi Chrome extension on a web form, or fill a PDF from your saved profile inside hivi.
4. Review and submit yourself through the official channel.

Why do it in hivi

Related Ontario forms repeat the same personal details. Captured once in hivi — stored in Canada, with AI on its own servers — every form starts mostly complete.