Submit influenza immunization reimbursement without retyping pharmacy billing details

Pharmacies claiming reimbursement for publicly funded influenza immunizations under the Universal Influenza Immunization Program repeat pharmacy name, billing number, address, and pharmacist contact on every reimbursement claim. 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: Vaccines and immunization — ontario.ca
• Form (Central Forms Repository): Universal Influenza Immunization Program Reimbursement Form — 014-4372-64

What this form is about

Form 014-4372-64 is the Universal Influenza Immunization Program Reimbursement Form, used by participating pharmacies to claim fees for administering publicly funded influenza vaccine — confirm fee schedules and claim periods on ontario.ca.

Before you start: what to gather

• Pharmacy legal name and address.
• Pharmacy billing or program identifier assigned for UIIP.
• Pharmacist-in-charge name and registration.
• Immunization counts and service dates for the claim period — confirm on ontario.ca.

Confirm the current process on ontario.ca.

How hivi makes it faster

1. Save it once. Store your pharmacy name, address, and billing contact 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.