Register Visudyne therapy funding without retyping patient and prescriber details

Ophthalmology practices enrolling patients in publicly funded Visudyne photodynamic therapy repeat patient legal name, health number, prescriber registration, and treatment site details on every registration 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: Exceptional Access Program — ontario.ca
• Form (Central Forms Repository): Visudyne Therapy Registration/Funding Enrollment — 014-3975-87

What this form is about

Form 014-3975-87 is Visudyne Therapy Registration/Funding Enrollment, used when prescribers register patients for ministry-funded Visudyne (verteporfin) therapy — confirm clinical eligibility and funding rules on ontario.ca.

Before you start: what to gather

• Patient full legal name and Ontario health number.
• Patient address and contact phone.
• Prescriber name and registration number.
• Treatment facility name and address.

Confirm the current process on ontario.ca.

How hivi makes it faster

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