Submit northern health program medical certificates without retyping patient and physician details

Physicians completing Medical Certificate Form 3 for First Nations and the North programs repeat patient name, identifiers, practice address, and physician billing details on every certificate. 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: Northern Health Programs forms — ontario.ca
• Form (Central Forms Repository): Medical Certificate Form 3 — 014-2862-69

What this form is about

Form 014-2862-69 is Medical Certificate Form 3, an application used by First Nations and the North health programs — confirm which northern or indigenous health initiative requires it on ontario.ca.

Before you start: what to gather

• Patient full legal name and health number or program identifier.
• Physician name, billing number, and practice address.
• Clinical findings supporting the certificate — complete yourself.
• Program or travel details — confirm requirements on ontario.ca.

Confirm the current process on ontario.ca.

How hivi makes it faster

1. Save it once. Store your patient and physician name, address, and billing 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.