Carealy - Revenue Addon

Private Patient Periodic visits – Non-Member Fee: $235, Plan Member Fee: $0

Private Patient Routine visits including children check-ups – Non-Member Fee: $100, Plan Member Fee: $0

Private Patient injections only without visit – Non-Member Fee: $20, Plan Member Fee: $0

Chart Transfer | Child – Non-Member Fee: $50, Plan Member Fee: $0

Chart Transfer | Adult – Non-Member Fee: $75, Plan Member Fee: $0

Work related to TB Test and Form – Non-Member Fee: $75, Plan Member Fee: $0

Warts (cryotherapy) – Non-Member Fee: $40, Plan Member Fee: $0

Ear syringe – Non-Member Fee: $40, Plan Member Fee: $0

Drivers Medical Exam/Pension Buy back and Form – Non-Member Fee: $250 – $300, Plan Member Fee: $0

Drivers Medical Form only – Non-Member Fee: $70, Plan Member Fee: $0

Aviation Medical Exams/forms – Non-Member Fee: $300, Plan Member Fee: $0

Ottawa Hospital/OC Transpo Medical Certificates – Non-Member Fee: $50, Plan Member Fee: $0

Camp, School, University forms – Non-Member Fee: $35, Plan Member Fee: $0

Routine Sick Notes/Back to work Notes – Non-Member Fee: $25, Plan Member Fee: $0

Jury Duty Letter – Non-Member Fee: $40, Plan Member Fee: $0

Drug Exemption Insurance forms – Non-Member Fee: $50, Plan Member Fee: $0

Paramedical Prescriptions (i.e., massage, physio etc. without appt) – Non-Member Fee: $25, Plan Member Fee: $0

Travel Cancellation Form – Non-Member Fee: $100, Plan Member Fee: $0

Functional Abilities forms – Non-Member Fee: $50, Plan Member Fee: $0

Pre-Adoption/Foster form only – Non-Member Fee: $100, Plan Member Fee: $0

Pre-Adoption/Foster exam + form (CAS) – Non-Member Fee: $250, Plan Member Fee: $0

Free communicable disease certificate – Non-Member Fee: $25, Plan Member Fee: $0

Vaccine review and forms (work/school) – Non-Member Fee: $40, Plan Member Fee: $0

Pre-Employment (i.e., Fitness/hospital/nursing) certificate – Non-Member Fee: $45, Plan Member Fee: $0

Modified Duty/Return to work treatment form – Non-Member Fee: $40-$100 (As per complexity), Plan Member Fee: $0

CPP Disability Medical Report Form (Government covers $85.00) – Non-Member Fee: Patient pays $65, $150 balance, Plan Member Fee: $0

CRA Disability Tax Credit (T2201) – Non-Member Fee: $100 (additional fees as per complexity), Plan Member Fee: $0

Federal Government Absence Certificate – Non-Member Fee: $50, Plan Member Fee: $0

Insurance forms – Non-Member Fee: $50-$300 (minimum $50, as per complexity), Plan Member Fee: $0

Attending Physician Statements – Non-Member Fee: $160 minimum – $160-$300 (as per complexity), Plan Member Fee: $0

OCF-3 Disability Certificate – Non-Member Fee: $240, Plan Member Fee: $0

OCF-18 Treatment Plan – Non-Member Fee: $255, Plan Member Fee: $0

OCF-19 Determination of Catastrophic Impairment – Non-Member Fee: $140, Plan Member Fee: $0

OCF-23 Treatment Confirmation – Non-Member Fee: $240, Plan Member Fee: $0

Life insurance Death Certificate – Non-Member Fee: $50, Plan Member Fee: $0

List of Uninsured Services