Services That are Not Covered By Alberta Health
Note of Illness/Return to Work
Physio/Massage Note
Seniors Residence Medical Report
Lab Results Printed
Disabled Parking Form
Blue Cross Special Authorization Forms
Alberta Human Services (Medical Report, AISH, CPP, etc.)
Long/Short Term Disability Form
Examination and Form Completion
Insurance Attending Physician Statement
General Insurance Eligibility
Driver’s Medical Exam
Senior Driver’s Medical Exam (75 years plus)
Third Party Requested Letters on Patient Attended
Proof of Death Physician’s Statement (other than Vital Statistics)
Other Simple Forms (e.g., Pregnancy, Functional Ability, Tax Credit)
Certification of Fitness for School
Certification of Fitness for Summer Camp, Daycare, Air Travel, etc.
Pre-Employment Medical Examination and Report
Injection (per)
Travel Medical Consult
No Show Appointment – General
No Show Appointment – Physical
Out of Country
No Alberta Health Care Office Visit (out of Province)
Photocopying or Printing
Transfer of Records to Physician
First 25 Pages plus $0.15 per Page Thereafter + Postage
Third Party Transfer of Records
Physician Statement: Lawyer/Insurance
Uninsured Wart/Mole Treatment (up to group of 3 per visit) – Non-Surgical
Faxing Charges
Note of Illness/Return to Work
$40.00
Physio/Massage Note
$30.00
Seniors Residence Medical Report
$75.00
Lab Results Printed
Disabled Parking Form
$70.00
Blue Cross Special Authorization Forms
$40.00
Alberta Human Services (Medical Report, AISH, CPP, etc.)
$100.00+
Long/Short Term Disability Form
Form Completion Only
$100.00+
Examination and Form Completion
$250.00+
Insurance Attending Physician Statement
$180 – $400
General Insurance Eligibility
Examination and Form Completion
$350.00+
Driver’s Medical Exam
$150.00
Senior Driver’s Medical Exam (75 years plus)
$90.00
Third Party Requested Letters on Patient Attended
$250.00+
Proof of Death Physician’s Statement (other than Vital Statistics)
$85.00
Other Simple Forms (e.g., Pregnancy, Functional Ability, Tax Credit)
$60 – $120
Certification of Fitness for School
Form Completion Only
$50.00
Examination and Form Completion
$150.00
Certification of Fitness for Summer Camp, Daycare, Air Travel, etc.
Form Completion Only
$50.00
Examination and Form Completion
$150.00
Pre-Employment Medical Examination and Report
$200 – $300
Injection (per)
$20.00
Travel Medical Consult
$100.00
Other
No Show Appointment – General
$40.00
No Show Appointment – Physical
$100.00+
Out of Country
$150.00+
No Alberta Health Care Office Visit (out of Province)
$75.00
Uninsured Wart/Mole Treatment (up to group of 3 per visit) – Non-Surgical
$20.00
Photocopying or Printing
$0.50/pg
Faxing Charges
$1.00/pg
Transfer of Records to Physician
$50.00
First 25 Pages plus $0.15 per Page Thereafter + Postage
Third Party Transfer of Records
$80.00 + $0.25/pg + Postage
Physician Statement: Lawyer/Insurance
$400.00
Chart Copies: Lawyer/Insurance
$400.00
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