FAQS

Questionaire

Uninsured
Services

Contact & Directions

Fees for Uninsured services

The following services provided by Dr. Rathbone’s office are not covered by the Ontario Health Insurance Plan, therefore they will be directly charged to the person or agency requesting them. The charges are subject to change, but new charges will be advised in writing to the requesting party prior to completion of the task.

Work & School Related Forms/Notes

Back to Work/School Notes…………………………………………………….$20.00

Jury Duty Notes………………………………………………………..…………..$25.00

Sick notes/Letter of Good Health………………………….……………….$20.00

Federal Employee Absence Notes (Blue Form)…………….…………$20.00

University/College/High School Absentee Note……………………..$30.00

Insurance Requirements

Doctor’s Order/Rx for Insurance Receipt……………………………….$20.00

Treatment Plan #OCF-18…………………………………………………….$100.00

Disability Certificate #OCF-3……………………………….……...…...$100.00

Certificate of Health Practitioner #OCF-8…………………….….…$32.00

Determination of Catastrophic #OCF-19/59………………………..
                                        To be determined at time of referral

Approval of Assess/Exam #OCF-22……………………………………..
                                        To be determined at time of referral

Travel Insurance Cancellation Form…………………..………………..$50.00

UIC Disability Certificate…………………………………….………………..$25.00

Attending Physician’s Statement………………………………………...$95.00

Licensing Forms/Certificates

Drivers Medical Exam (FLRC80), Form, Physical Examination and

Chart Review……..……………………………………………………………….$177.50

Drivers License (Post) Revocation Report……………………………$50.00

Government Forms:

Citizenship and Immigration Canada, Medical Report for Immigration……............................................................$95.00

CPP Disability Report Form…………………………………………………….$95.00

(The Federal Government Covers $65.00 for completion of the report, and

Dr. Rathbone will bill the remainder $30.00 to the requesting party)

Requests for Medical Information Regarding the Applicants to

Canadian Armed Forces……………………………………….………………….$75.00

Revenue Canada Disability Tax Credit……………………………………..$35.00

Auto Sales Tax Rebate Form…………………………………………………….$25.00

Other Forms:

Orthotics, Massage Therapy, Physiotherapy Referral Forms…………………...................................................….$15.00

Respite Form………………………………………………………………………..$25.00

Office Related Costs

Missed Appointment Without 72 hour Cancellation

Follow-up appointment ……………………………………….………….....50%

Consultation appointment……………..………………….…………..$100.00

NSF Cheques………………………………………………….…………….….$50.00

Patient Requests For Photocopying

For Pages 1-10………………………………………………………….………$100.00

For Pages 11+……………………………………………………………….$1.50 per page

With Diligent Review/Exclusions, etc.

For Pages 1-10……………………………………………….……….……..$115.00

For Pages 11+………………………………………………...……….$2.25 per page

Medical/Legal/Insurance/Private Rehabilitation

Medical/Legal/Insurance/Rehabilitation Photocopying…….………$170.00 first 25 pages

Additional Pages (26+)…………………....……………….$1.00 per page thereafter

Medical/Legal/Insurance/Rehabilitation Chart Demand Surcharge

1 day or less……………………………………….…………………………$125.00

< 2 days………………………………………………………………………$100.00

<4 days………………………………………………………………………..$75.00

<7 days………………………………………………………………………..$50.00