Certify specialist services for travel grant claims without retyping provider and patient details

Specialist physicians and facilities completing the Northern Health Travel Grant specialty-service provider form repeat patient name, health number, practice address, and billing identifiers on every certification. 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 Travel Grant Program — ontario.ca
• Form (Central Forms Repository): Specialty-Service Provider Form for Northern Health Travel Grant — on00857

What this form is about

Form ON00857 is the Specialty-Service Provider Form for the Northern Health Travel Grant, used when a specialist confirms that a Northern Ontario resident travelled for an eligible specialist service — confirm program rules on ontario.ca.

Before you start: what to gather

• Patient full legal name and Ontario health number.
• Specialist name, registration number, and practice address.
• Service date, specialist service provided, and referral details.
• Travel or appointment information linked to the patient's claim — confirm on ontario.ca.

Confirm the current process on ontario.ca.

How hivi makes it faster

1. Save it once. Store your patient health number and specialist practice 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.