Attach co-payment documents after a benefit change without retyping resident details

Long-term care homes and residents who transitioned between Ontario benefits repeat the resident's name, health number, home name, and representative contact when submitting a notice of assessment and the support document list for co-payment reassessment. 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: Paying for long-term care — ontario.ca
• Form (Central Forms Repository): Long-Term Care Home Support Document List - Submitting NOA that included benefit(s) that a resident is no longer receiving because they have transitioned to new benefit(s) — 014-4817-69

What this form is about

Form 014-4817-69 is the Long-Term Care Home Support Document List for residents submitting a notice of assessment that included benefits they no longer receive because they transitioned to new benefits, used when reassessing basic accommodation charges.

Before you start: what to gather

• Resident full legal name and Ontario health number.
• Long-term care home name and address.
• Notice of assessment and documents for the new benefit — confirm list on ontario.ca.
• Representative name and contact if someone signs on the resident's behalf.

Confirm the current process on ontario.ca.

How hivi makes it faster

1. Save it once. Store your resident name, health number, and home 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.