Clinical Services
100Uninsured office visit (age 2-49)125
120Uninsured complete physical exam (age 2-49)160
Missed 10-minute appointment50
Missed long appointment80
00190+00044Cryotherapy for non-insured lesions60
13620 +00090Excision Mole (cosmetic)-non facial150
Injections (such as flu shots) for non eligible patients40
A00049Advice by telephone on the establishing of a tentative diagnosis and prescribing treatment per 15 minutes or portion thereof80
A00001General Insurance Examination, industrial (to include M.O.T.
$195.00 examinations for pilots and air traffic controllers), pre-placement and periodic examinations, CPP examinations
200
96220OSMV Driver’s Medical Examination and Report (DMER)
– stand-alone
200
A00068Physical fitness examination for school, summer camp, etc., including certificate
A00058
70
Non-clinical Services
A00060One-page forms including: School/Work time off, Government UIC form, Parking form, Handi dart application40
A00070For filling out an ordinary printed form reporting on a patient’s condition or submitting like information in letter form, such as Employer’s Work Capability form165
A00070Insurance Company typed letter
-short (½ page), Typed off work letter
165
A00071A 5 or form is defined as a short factual written communication given to any lay person (e.g. lawyer, insurance representative) in relation to a patient for some purpose primarily unconnected with treatment345
A00072A Medico-Legal Report is one, which will recite symptoms, history and records and gives diagnosis, treatment, results and present condition.
This is a factual summary of all the information available on the case. It could also contain prognostic information about when the patient will be able to return to work and might
mention whether there will be a permanent disability
1030
A00073A Medico-Legal Opinion will usually include the information contained in the medical – legal report and will differ from it primarily in the field of expert opinion. This may be opinion as to the course of events when these cannot be known for sure. It can include opinion as to long term consequences and possible complications in the further development of the condition. All the known facts will probably be mentioned, but in addition there will be extensive exercise of expert knowledge and judgement with respect to those facts with a detailed prognosis.1725
A00095Review of EMR records (15 min)100
A00047Renewal of prescription by fax or telephone (per call)30
A00093Transferring charts out of clinicThis fee is recommended for a simple transfer of records. Photocopying may be charged in addition.
ii). Other direct costs, such as courier services, may be charged in addition based on the actual cost.
iii). A fee for review of records may be charged in addition if the physician reviews the records for the purpose of selecting current and necessary medical information to be transferred.
iv). Original records must be retained by the transferring physician as required by Law
v). When multiple records are being transferred, the total time spent should be taken into account.
50
A00096Photocopying per page (paper copies) (first 10 pages)
– subsequent pages – 30¢ per page
NOTES:
i) A00096 is extra to A00093 and/or A00095
ii) The fee for this service does not include review and/or summary of the patient’s chart
1.65
A94523Completion of Drug Benefit Form for third party insurer (including non-indicated Special Authority forms)75
A00069Insurance company form to include review of records-short report (1 page)145
A00059Insurance company form to include review of records-long report (more than 1 page)190

*Our fees are subject to change.