Request OHIP reimbursement for out-of-province outpatient care without retyping your details

Patients seeking OHIP reimbursement for outpatient services received outside Ontario repeat their name, health number, address, and itemized service information on every claim form. 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: OHIP coverage while outside Canada — ontario.ca
• Form (Central Forms Repository): Out of Province Out-patient Services — 014-7521-84

What this form is about

Form 014-7521-84 is the Out of Province Out-patient Services claim form, used by OHIP-insured residents to request reimbursement for eligible outpatient services received in another province.

Before you start: what to gather

• Your full legal name and Ontario health number.
• Mailing address and contact information.
• Outpatient service dates, facility, and procedure details.
• Receipts and supporting statements — confirm document requirements on ontario.ca.

Confirm the current process on ontario.ca.

How hivi makes it faster

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