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OHIP Health Card Updated Form

We require an up-to-date OHIP card number with version code in order to properly bill and track services provided to you under OHIP (Ontario Health Insurance Plan). Failure to provide a valid version code may restrict your ability to receive imaging, laboratory testing and other OHIP funded services.

Please take the opportunity to provide us with your updated health card information. Your health card number does not change, but your version code does. The sample below illustrates where you will find important information.

Solid yellow rectangle - OHIP Number
Red oval - Version Code
Dotted yellow rectangle - Expiry Date

 Update my Health Card

If your contact information has changed, such as your address, phone number or email, please let us know by completing the form below. 

Update my Demographics Form

Disclosure of Medical Information

There may be circumstances when as a patient you prefer or require a designated relative or friend of your choosing to receive your medical information. These reasons may include:

  • Language or communication barriers
  • Difficulty understanding medical information
  • Difficulty with recording details or appointment information due to disability or other impairments

Examples of the types of medical information that may be relayed to your designated relative or friend include:

  • Medical history
  • Test results
  • Diagnosis
  • Treatment plan
  • Medications
  • Appointment information
  • Appointment reminders

By filling out this following form, you as the patient give New Vision Family Health Team permission to disclose all or select aspects of your medical information to your designated relative of friend. Social work consult notes are not included in this consent and will not be disclosed.

Be aware there are inherent risks with disclosing your medical information to your designated person. Appropriate or inappropriate dissemination of your medical information by your designated person may have foreseen or unforeseen negative consequences, personal or financial.

Please note: If you already have power of attorney papers pertaining to personal care, you still need to fill out this form as power of attorney does not take effect until you are incapable of making decisions. A copy of your power of attorney should still be brought into our office so we can take a copy for your chart.

Medical Disclosure Form